Laparoscopic Interval Appendectomy as Safe and Effective Treatment of Complicated Appendicitis after Failed Initial Conservative Approach: A Single-Center Experience.

Abstract

Background: Following the COVID-19 pandemic, antibiotic therapy has become the first-line treatment for acute appendicitis (AA) in many centers. Interval appendectomy (IA) is often needed later due to symptom recurrence. This paper aimed to report our experience with early, unplanned laparoscopic IA (LIA) over the past 2 years. Materials and Methods: All patients with previous AA initially managed with antibiotics who underwent LIA due to symptom recurrence over the period January 2022-March 2024 were enrolled. Parameters assessed included patients' characteristics and operative outcomes. Results: The patient cohort included 40 girls and 31 boys, with a median age of 13.3 years (range 9-17). All LIAs were accomplished laparoscopically without conversions or intraoperative complications. The median operative time was 27 minutes (range 15-48). The appendix was ligated using two endoloops in 28/71 (39.4%) and resected using an automatic stapler in 43/71 (60.6%). A retrocecal appendix was found in 25/71 (35%), and adhesions between the appendix and the surrounding tissues in 31/71 (43%). Parasitic helminths were found in the lumen of the appendix in 5/71 (7%). Meckel's diverticulum was negative in all cases. The median hospitalization was 32 hours (range 26-50). No postoperative complications occurred. Pathology confirmed intramural inflammation with peri-appendiceal fibrosis in all patients. Conclusions: Our study confirms that early laparoscopic appendectomy is a safe and feasible option after failed nonoperative management of complicated appendicitis. All procedures were completed laparoscopically without complications. Given the presence of adhesions and retrocecal appendix in many cases, further studies are needed to refine optimal treatment strategies and timing.