Laparoscopic Management of Periappendicular Abscess

According to retrospective studies the conservative management of periappendicular abscess is associated with decreased complication and re-operation rate compared with open appendectomy. Large abscesses require percutaneous drainage. Sometimes percutaneous drainage is not possible because of anatomical position of the abscess and surgical treatment is needed. The purpose of this study is evaluate whether laparoscopic appendectomy is suitable for the first-line treatment in patients with periappendicular abscess. The hypothesis of the study is that laparoscopic management of periappendicular abscess is suitable for the first-line treatment and it does not increase time of hospitalization or complication rate compared with conservative management.

Patients are treated with intravenous Cefuroxime 1,5 g x 3 per day plus Metronidazole 500 mg x 3 per day. If the abscess is at least 3 cm in diameter percutaneous ultrasound guided drainage is performed.

Laparoscopic appendectomy and laparoscopic drainage of the abscess. If appendectomy is not possible due to technical difficulties only laparoscopic drainage is performed. Patients are treated with the same antimicrobial therapy as the control group

Laparoscopic appendectomy and laparoscopic drainage of the abscess. If appendectomy is not possible due to technical difficulties only laparoscopic drainage is performed. Patients are treated with the same antimicrobial therapy as the control group (intravenous Cefuroxime 1,5 g x 3 per day plus Metronidazole 500 mg x 3 per day).

Patients are treated with intravenous Cefuroxime 1,5 g x 3 per day plus Metronidazole 500 mg x 3 per day. If the abscess is at least 3 cm in diameter percutaneous ultrasound guided drainage is performed.

In the laparoscopy group appendectomy was not possible. In the conservative group planned percutaneous drainage was not possible.

Any complication occurring within 60 days from randomization. Both medical and surgical complications are included.

Inclusion Criteria: Periappendicular abscess at least 2 cm in size Exclusion Criteria: Missing written informed consent Antimicrobial therapy lasted over 24 hours before randomization Attempt of drainage before randomization Age over 80 years or under 18 years old Pregnancy Allergy to either Cefuroxime or Metronidazole Severe chronic disease, that substantially increases the risk for operative mortality Previous major intra-abdominal surgery, that may have caused intra-abdominal adhesions Carrier of a resistant bacterial strain Being institutionalized or hospitalized for at least 2 weeks before randomization