Prevention of intra-abdominal abscess following laparoscopic appendicectomy for perforated appendicitis: a prospective study.

BACKGROUND: Laparoscopic appendicectomy is gradually being accepted as a procedure of choice in the management of suspected acute appendicitis. (in female of childbirth and obese patients, working class, children and elderly). The aim of this study is to assess the feasibility and safety of laparoscopic appendicectomy for perforated appendicitis and to assess our simple technique to reduce postoperative infective complications of perforated appendicitis.

METHODS: This is a prospective study for all patients who were admitted through the Accident and Emergency Department with a diagnosis of perforated appendicitis confirmed during diagnostic laparoscopy and subsequently managed by laparoscopic appendicectomy. All patients had surgery within 24h of admission. There were no conversions to open appendicectomy, although patients were also consented for this. All patients were followed up in the out patient clinic.

RESULTS: A total of 283 patients were admitted with a diagnosis of acute appendicitis from May 2005 to February 2008. Twenty-two (7.77%) patients were diagnosed with perforated appendicitis. There were 9 (40.90%) men and 13 (59.09%) women. The ages ranged from 7 to 76 years. The length of stay ranged from 6 to 21 days. ASA ranged from 1 to 3. Morbidity was 18.18% and no mortality was reported.

CONCLUSION: Perforated appendicitis can be managed effectively and safely using a laparoscopic technique. Timing of intervention and operative technique which includes four abdominal quadrants copious irrigation is important to prevent postoperative intra-abdominal abscesses.