Interval laparoscopic appendectomy after antibiotic therapy for appendiceal abscess in elderly patients

Abstract

IntroductionThe aim of this study was to evaluate the safety and efficacy of interval laparoscopic appendectomy after antibiotic therapy in elderly patients with appendiceal abscess.MethodsWe retrospectively analyzed data for 50 patients with appendiceal abscess aged ≥18 years who had initially planned to undergo interval laparoscopic appendectomy after antibiotic therapy and 50 patients with appendicitis aged ≥70 years who had undergone early laparoscopic appendectomy. All patients were treated at the National Hospital Organization Kumamoto Medical Center between 2012 and 2018. We compared perioperative outcomes after interval appendectomy between patients aged <70 years and ≥70 years.ResultsClinical progression of appendicitis during antibiotic therapy developed in one patient (2.0%), and recurrent appendicitis after antibiotic therapy for appendiceal abscess occurred in two patients (4.0%). Pathological findings confirmed appendiceal neoplasms in four patients (8.0%). Postoperative infectious complications occurred in 1 of 47 patients (2.1%) who had undergone successful interval laparoscopic appendectomy, and the median length of postoperative hospital stay was 4 days (interquartile range, 3‐5 days). There were no significant differences in outcomes after interval appendectomy between patients aged <70 years and ≥70 years. In the secondary analysis, the median length of postoperative hospital stay after interval laparoscopic appendectomy for appendiceal abscess (4 days) was significantly shorter than that after early laparoscopic appendectomy for uncomplicated appendicitis (7 days; P < .001).ConclusionsInterval laparoscopic appendectomy for appendiceal abscess may be safe and effective in elderly patients without severe comorbidities. Interval appendectomy may be necessary for determining the underlying cause of appendiceal abscess in adults.

The Impact of the Coronavirus Disease - 19 Pandemic on the Clinical Characteristics and Treatment of Adult Patients with Acute Appendicitis

“…The incidence of interval appendectomy may be increased due to the increase in cases of complicated appendicitis resulting from delayed time from symptom onset to ER visit. According to previous studies, interval appendectomy was not inferior to the initial surgical approach in terms of reducing postoperative morbidity ( 16 , 32 ). Although the initial surgical approach was still preferred in South Korea, interval appendectomy increased as the proportion of complicated appendicitis cases increased during the pandemic.…”

Acute Appendicitis in the Elderly: A Literature Review on an Increasingly Frequent Surgical Problem

“…It is known that 28.6–58% appendiceal tumors present as acute appendicitis [ 55 , 56 ]. Interval appendectomy is safe to perform laparoscopically in selected individuals without co-morbidities [ 57 ].…”

Comparison of Clinical Features and Outcomes of Appendectomy in Elderly vs. Non-Elderly: A Systematic Review and Meta-Analysis

“…Out of the remaining 75 studies, 60 were excluded after reading the full text. Finally, a total of 15 studies were considered for inclusion (5,(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). Table 1 presents the details of the studies included in the review.…”