Outcomes of an emergency laparoscopic-first strategy for appendiceal abscess: a 10-year retrospective case series of 137 patients

Background: Appendiceal abscess management remains debated. Non-operative treatment may control sepsis in selected patients, whereas immediate laparoscopy provides definitive source control but is technically demanding. We evaluated the 30-day outcomes of an emergency laparoscopic-first strategy. Methods: This single-center, retrospective case series included consecutive eligible patients undergoing emergency laparoscopic-intent surgery for operatively confirmed appendiceal abscess from 2013 to 2022. Primary outcomes were 30-day morbidity and mortality; secondary outcomes were conversion, operative duration, length of stay, and reintervention. Results: A total of 137 patients were included; mean age was 41.6 years (range, 15–84), and 85 (62.0%) were men. Laparoscopy was completed in 100 patients (73.0%); 37 (27.0%) required conversion, most often due to a difficult appendiceal base (18 of 37). Median operative duration was 120 minutes (range, 55–280), and median postoperative stay was 5 days (range, 1–13). Overall and surgery-specific morbidity rates were 10.2% and 5.8%, respectively. The latter comprised three wound abscesses and five intra-abdominal collections, including one stump leak. Two collections were treated with antibiotics alone, two with percutaneous drainage, and one with surgical drainage. There was no postoperative generalized peritonitis and no 30-day mortality. Conclusions: In this selected cohort managed under senior supervision, emergency laparoscopic-first surgery was completed laparoscopically in 73.0% of patients, while 27.0% required conversion. When surgery is selected, this approach may be considered in a service able to provide experienced senior supervision and timely conversion. These descriptive findings do not establish superiority over non-operative or delayed treatment.