Abstracts
1998 Digestive Disease Week

#1059

INTERVAL APPENDECTOMY IN THE LAPAROSCOPIC ERA. DB Nguyen, W Silen, and RA Hodin, Dept of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

In the acute setting, patients with periappendiceal masses generally improve with broad spectrum antibiotics +/- percutaneous catheter drainage, but whether or not to perform an interval appendectomy remains controversial. We have analyzed our experience with interval appendectomy over the last decade, comparing results from laparoscopic (LAP) and open (STD) cases. METHODS: Medical records were reviewed for 56 patients who initially presented with the diagnosis of periappendiceal mass or abscess and data accumulated for both the initial hospitalization and subsequent interval appendectomy. Comparisons were made between Period I ('87-'93) and Period II ('94-'97). Followup data were obtained via telephone conversation with the patients. RESULTS: Patient characteristics in regard to age, gender, and comorbidities did not differ between the LAP and STD cases. (1) Period I vs II: The number of patients undergoing CAT scan increased from 61% to 72%, whereas the initial hospital stay decreased from 6.4 to 4.7 days, p<0.01. The percentage of interval appendectomies performed by LAP method increased from 30 to 85. (2) LAP vs STD: The total operating room time did not differ (95 vs 103 min) but the hospital stay was much shorter in the LAP group (0.55 vs 3.09 days, p<0.001). There were no instances of intraabdominal or wound infections in either group. In the later time period, the mean hospital stay decreased to 0.38 days, with 59% of the cases performed on an outpatient basis. Following LAP, narcotic pain medication was used for an average of 1.3 days and the reported "time to return to full activities" was 2.5 days. CONCLUSIONS: Laparoscopic interval appendectomy is a simple and safe procedure which can usually be performed on an outpatient basis. Given the minimal morbidity of the procedure, we believe that interval laparoscopic appendectomy should be considered for most patients who initially present with periappendiceal masses.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.