Management of Postappendectomy Intra-Abdominal Abscesses: A Minimally Invasive Approach

Abstract

Background: Children with appendicitis frequently (15%–50%)resent with a rupture, after which, postappendectomy intra-abdominal abscesses are common. Management options to date have been percutaneous or open drainage. Patients and Methods: Nine laparoscopic drainages for postappendectomy intra-abdominal abscesses were performed on seven boys and one girl aged 3 to 14 years between March 1996 and January 1999. There were six open and two laparoscopic appendectomies for seven ruptured and one acute appendicitis. Postoperatively, all patients had fever with leukocytosis. The CT scans of the abdomen showed intra-abdominal collections. The average time to the drainage procedure was 8.5 days. Laparoscopic drainage was selected in cases of multiple abscesses or absence of a percutaneous window. Results: There were no deaths or conversions to an open procedure. The median operative time was 2.27 hours. The hospital course was characterized by fever for 2 days, abdominal pain for 2 or 3 days, an average drainage of 255 mL, and an average antibiotic duration of 7 days. Complications were one urinary tract infection and one reaccumulation, which was drained laparoscopically. The average postoperative length of stay was 7 days. All patients were doing well at 3-week follow-up. Conclusions: Laparoscopic drainage of postappendiceal intra-abdominal abscesses can be performed with no increased risk of complications and with less morbidity than an open procedure. It should be part of the pediatric surgeon's armamentarium.