Incidence of postoperative intraabdominal abscesses in open versus laparoscopic appendectomies

Risk for intraabdominal abscess (IAA) after laparoscopic appendectomy (LA) remains controversial. A 2008 Cochrane Review suggests almost a threefold increase in the incidence of IAA after LA compared with open appendectomy (OA). The authors conducted a retrospective chart review of all appendicitis patients 18 years and older undergoing appendectomy from 1996 to 2007 at one military treatment facility and one civilian hospital in Hawaii. Data collection included demographics, procedure, presence of complicated appendicitis (defined as perforated or gangrenous appendicitis at surgical or pathologic assessment), and presence of postoperative IAA on computed axial tomography (CAT) scan. The review identified 2,464 patients with appendicitis. A total of 1,924 LAs (78%) and 540 OAs (22%) were performed. The comparison of laparoscopic and open appendectomies showed no significant differences in the number of postoperative abscesses (2.2% vs 1.9%; p = 0.74). The patients with a diagnosis of complicated appendicitis were significantly associated with a higher incidence of postoperative abscess formation (67% vs 25%; p < 0.01), which had an unadjusted odds ratio of 6.1 (95% confidence interval [CI], 3.4-11.0; p < 0.01). No significant difference in the development of abscess in patients with complicated appendicitis could be found between LA and OA (5.9% vs 4.1%; p = 0.44). No significant difference in the occurrence of IAA after LA versus OA was found. The patients with complicated appendicitis experienced a greater number of IAA than the patients with uncomplicated appendicitis.