Laparoscopic Management of Periappendicular Abscess

Helsinki University Central Hospital60 enrolled

Overview

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.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Appendicitis Abdominal Abscess

Interventions

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).

Eligibility

Sex: ALLMin age: 18 YearsMax age: 80 Years

Medical Language ↔ Plain English

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

Outcomes

Primary Outcomes

Time of hospitalization within the first 60 days after randomization

Time frame: Day 60 after randomization

Secondary Outcomes

Need of additional interventions

Interventions include percutaneous drainage and operations

Time frame: Within the first 60 days after randomization

Residual abscess

Time frame: On day 7 after randomization

Attempted procedure not successfully performed

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

Time frame: During the first 24 hours after randomization

The number of complications

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

Time frame: Within 60 days from randomization

Number recurrent abscesses

Time frame: Within 60 days after randomization