Compared to OAs, LAs typically resulted in less post-operative pain; on day

1 after surgery, patients who underwent a laparoscopic procedure reported reduced pain by click here 8 mm on a 100 mm visual analogue scale compared to patients who had undergone the open procedure. Further, the overall hospital stay was reduced for patients who underwent LAs compared to those who underwent OAs. While the operational costs of LAs were significantly higher, the costs associated with recovery were substantially reduced. 7 studies of children were included in the review, but the results did not differ significantly from those of similar adult-focused studies. Diagnostic laparoscopy reduced the risk of unnecessary appendectomies, though this trend was most common in fertile women as compared to unselected adults [33]. However, in many cases the strong predictive power of CT and ultrasound analysis renders the diagnostic laparoscopy clinically superfluous. In 2011, Masoomi et al. used the Nationwide Inpatient Sample Database to evaluate the clinical data of adult patients in the United States who had undergone

either LAs or OAs for suspected acute appendicitis from 2006 to 2008 [34]. A total of 573,244 adults underwent emergency appendectomies during this 3-year period. Overall, 65.2% of all appendectomies were performed laparoscopically. Use of the laparoscopic approach increased 23.7% from 58.2% in 2006 to 72% in 2008. In the context of acute non-perforated appendicitis, LAs featured lower overall complication rates, lower in-hospital mortality rates, and a shorter mean length of GW786034 hospitalization Selleckchem Lazertinib compared to the open procedure. Routine use of intraoperative irrigation isothipendyl for appendectomies does not prevent intra-abdominal abscess formation, adds extra costs, and may be avoided (Recommendation 2B). Recently a retrospective review of 176 consecutive appendectomies, open (39%) and laparoscopic (61%), at a university affiliated tertiary care facility from July 2007 to November 2008 investigated routine use of intraoperative irrigation for appendectomies.

The results did not show decrease in postoperative intra-abdominal abscess with use of intraoperative irrigation. Thirteen patients developed postoperative abscess: 11 with irrigation, two without irrigation. Ten of 13 patients who developed abscess were perforated; nine with irrigation and one without [35]. Patients with periappendiceal abscesses should be treated with percutaneous image-guided drainage. (Recommendation 1B). Current evidence demonstrates that an interval appendectomy is not routinely necessary following initial non-operative treatment of complicated appendicitis. However, interval appendicectomies should always be performed for patients with recurrent symptoms (Recommendation 2B). For patients with acute appendicitis presenting with abscesses, the optimal management strategy is somewhat controversial.