Early versus Interval Laparoscopic Appendectomy for Appendicular Abscess: A Prospective Randomized Comparative Study

Abstract

The optimal timing for laparoscopic surgery in patients presenting with an appendicular abscess remains controversial. Management strategies include immediate laparoscopic drainage and appendectomy versus initial conservative treatment with antibiotics, with or without percutaneous drainage (PCD), followed by delayed interval appendectomy. This study aimed to compare early versus delayed laparoscopic intervention in terms of technical difficulty, safety, and postoperative outcomes. This prospective randomized trial included 50 patients diagnosed with appendicular abscess, equally allocated into two groups: the Early Laparoscopic Group (ELG, n=25), who underwent immediate laparoscopic drainage and appendectomy, and the Delayed Laparoscopic Group (DLG, n=25), who received initial conservative management followed by interval laparoscopic appendectomy after 6–8 weeks. The primary outcome was postoperative complications, including fecal fistula and intra-abdominal collections. Secondary outcomes included operative time (min), hospital stay, conversion rate, and overall treatment success. Baseline demographic, clinical, and radiological characteristics were comparable between the groups. The mean operative time was significantly longer in the ELG (105.4 ± 18.7 min) compared to the DLG (68.2 ± 15.3 min; P<0.001). Conversion to open surgery occurred more frequently in the ELG (16%) compared to the DLG (4%), although this difference was not statistically significant (P=0.35). The total hospital stays over the entire treatment period showed a trend toward being shorter in the ELG (6.1 ± 2.1 days) compared to the DLG (8.5 ± 3.4 days), although this did not reach statistical significance (P=0.06). Postoperative fecal fistula occurred in 2 patients (8%) in the ELG and in none of the patients in the DLG (P=0.49). During the waiting period, 2 patients (8%) in the DLG developed recurrent collections, both managed conservatively, while no postoperative collections were observed in the ELG. Additionally, 4 patients (16%) in the DLG required readmission or unplanned intervention prior to scheduled surgery. Both early and delayed laparoscopic approaches are viable options for managing appendicular abscess. Early intervention offers a single-stage treatment and eliminates the risk of recurrence during the waiting period, but is associated with longer operative time and a tendency toward higher postoperative morbidity. Delayed laparoscopic appendectomy is technically less demanding but requires an initial conservative phase, with a risk of treatment failure and the need for multiple hospital admissions. Careful patient selection and shared decision-making remain essential.