The Assessment of Perioperative Outcome and Cost-effectiveness of Laparoscopy versus Open Surgery in the Management of Periappendiceal Abscess: A Comparative Multicentric Study

Aim: To investigate the perioperative outcomes and cost-effectiveness of the laparoscopic approach for patients with periappendiceal abscess (PA) in comparison with the open approach. The controversy is still evolving as regards laparoscopic surgery in cases with complicated appendicitis in general. Materials and methods: Three-center analysis of the records’ data of candidates >14 years of age with PA operated from January 2017 until October 2020 by either laparoscopic or open approach. Demographic and clinical data, perioperative outcomes, and cost-effectiveness were recorded and analyzed. Results: Within the study period, 399 eligible cases with PA were identified by clinical evaluation conjoined with the US and/or CT, of which 143 patients underwent laparoscopic appendectomy (LA) and 256 patients had an open appendectomy (OA). The average operating time was 78 minutes for the LA group and 62 minutes for the OA group (p < 0.001). The mean hospital stay was 6.3 days for LA and 7.4 days for the OA group (p < 0.001). There were 18 cases in the LA group who had surgical site infections, and there were 27 ones in the OA group (p = 0.001). There were six patients who suffered from a recurrent intra-abdominal collection in the LA group and four cases in the other group (p = 0.37). Laparoscopic appendectomy had a lower odds for the development of any specific surgical complication in the multivariate analysis (OR, 0.381, p = 0.008). The total expenses of management were marginally higher by about $300 in the LA group. Conclusions: Laparoscopic appendectomy is an efficient and safe operative approach in the management of PA, and it exhibits clinically beneficial merits over OA against marginally longer operating time and higher management expenses. Clinical significance: Laparoscopic surgery for appendicitis complicated with an abscess is feasible and safe. It offers beneficial merits over the open approach.