Laparoscopic Management of Appendicular Abscess Versus Interventional Radiology | ||
| Zagazig University Medical Journal | ||
| Articles in Press, Accepted Manuscript, Available Online from 19 September 2025 | ||
| Document Type: Original Article | ||
| DOI: 10.21608/zumj.2025.414149.4111 | ||
| Authors | ||
| Said Mohamed Negm1; Morsi Mohamed Morsi2; Mostafa Ahmed Ahmed Ibrahiem* 3; Baher Atef Gamil4; Ahmed Shafiq4 | ||
| 1Lecturer of General Surgery, Faculty of Medicine, Zagazig University, Egypt | ||
| 2Professor of General Surgery, Faculty of Medicine, Zagazig University, Egypt | ||
| 3Department of General Surgery, Faculty of Medicine, Zagazig University, Egypt | ||
| 4Lecturer of General Surgery , Faculty of Medicine, Zagazig University, Egypt | ||
| Abstract | ||
| Background: Appendicular abscess is one of the most serious complications of acute perforated appendicitis, with management options including interventional radiology-guided drainage or laparoscopic drainage with appendectomy. This study aimed to compare laparoscopic management versus interventional radiology in terms of efficacy, safety, and postoperative outcomes. Methods: This prospective randomized trial, 52 patients with appendicular abscess were equally randomized into two groups: laparoscopic (Group A) and Interventional Radiology )IR( (Group B). The primary outcome was postoperative fecal fistula; secondary outcomes included recurrent collection, return to normal activity, quality of life, and patient satisfaction. Results: Radiological findings showed no significant differences in appendix diameter or abscess size, though CT was more sensitive than ultrasound in detecting abscesses, appendicoliths, and peri-appendiceal fluid. Operative time was longer in Group A (88.1±21.5minvs. 46.2±10.9min, P<0.001), but hospital stay was shorter (4.77±1.53vs. 7.73±2.79 days, P<0.001). Postoperative fecal fistula occurred in 0% of Group A and 15.4% of Group B (P=0.11). Laparoscopy led to faster return to normal activity (15.8±3.41vs. 20.5±3.7 days, P<0.001), better quality of life (65.4% excellent vs. 15.4%, P<0.001), and higher satisfaction (100%vs. 76.9%, P=0.022). Recurrence occurred in 19.2% of IR patients versus none in the laparoscopic group. One mortality occurred in the IR group due to bowel injury and sepsis. Conclusion: For appendicular abscesses, laparoscopic therapy is a safe and efficient one-session procedure when performed by skilled professionals. It avoids interval appendectomy, reduces hospital stay, improves quality of life, and lowers recurrence compared to IR, supporting its role as the preferred approach in suitable patients. | ||
| Keywords | ||
| Appendicular abscess; Laparoscopy; Interventional radiology; Appendectomy | ||
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