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Aziz et al. Laparoscopicsuction in paediatrics post-appendectomy

They also complaint of pain at the site of the pigtail- collection in the pelvis; the patient also had persistent
catheter and difficulty to mobilise, having to carry the high-grade fever (39 °C). DLS was performed at POD4;
catheter and drainage bag all the time. However, their the fever settled within 24 h and patient was discharged
appetite improved after the percutaneous drainage. two days after DLS. All 7 patients who underwent DLS
They were discharged at POD10 and POD14 did not have any complications such as bowel injury,
respectively after repeat ultrasound showed complete serosal tear or any difficulty in suctioning out the IAA
resolution of IAA and removal of the pigtail-catheter. during procedure.
At follow up, 1 patient complaint of pain at the right
iliac fossa with no symptoms to suggest adhesive Comparing the patients who underwent DLS and those
obstruction. A repeat ultrasound was done for him who had percutaneous drainage, the DLS-group had
which was normal. The second patient remained well early cessation of fever (a day after the procedure);
at follow-up. they also went home earlier than the percutaneous
group (at about 2-3 days post-DLS and total length of
One patient with IAA of 3 cm × 4 cm was treated stay in the ward did not exceed more than a week).
conservatively; intravenous Gentamycin was added The percutaneous-drainage-group took longer time to
and she became afebrile 48 h later. This patient’s become afebrile (fever was settled after more than a
appetite took longer time to resolve, however she did week); they also had additional pain and discomfort
not complain of abdominal pain. She was subsequently from the pigtail-insertion. They also stayed longer in
discharged well at POD7. Repeat ultrasound was not the ward (10 and 14 days).
done on her before discharge; at follow-up, she was
also well. Follow-up was carried out at 1-month post-surgery,
all DLS-grouped patients remained well clinically and
Six other patients with IAA of more than 5 cm × 5 cm backed to their normal selves. The histopathological
on were subjected to DLS. All of them were febrile examinations of their appendix confirmed perforated
with temperature of 38 °C or more at POD3. Three appendicitis. None of the patients had symptoms for
patients had no abdominal pain and their appetite
were normal. Three other patients have either one or adhesive obstruction.
more combination of symptoms e.g. fever, abdominal
pain, poor appetite and refusal to mobilise [Table 1]. All DISCUSSION
6 patients underwent DLS at POD3 to POD5 via the
[5]
same port-sites used during first surgery. No additional A study published in 2014 by Taguchi et al. from
antibiotics was given. During DLS, intraoperatively, only Nagoya Red Cross Hospital, Japan, showed no
laparoscopic suction was carried out without irrigation. significant difference in the incident of IAA formation
Post procedure, fever resolved within 24 h of DLS in all between LA and OA in treating complicated
6 patients. Patients who had complaints had complete appendicitis i.e. 17 vs. 20. This single-centre
resolution of their symptoms. They were discharged as randomized-controlled trial was conducted with the
early as second to third day post-DLS. The 7th patient development of an infectious complications including
included in this review was a patient who underwent IAA formation as primary outcome. In this study, the
open appendectomy for perforated appendicitis at operating surgeon performed thorough peritoneal
another institution. The appendectomy scar was lavage using several liters of warm saline regardless
consistent with a standard Lantz incision about 5 cm of whether an abscess or peritonitis was present. This
in length. The patient was referred to us at POD3 study showed the safety and feasibility of the usage
after abdominal ultrasound revealed an 8 cm × 5 cm of LA for complicated appendicitis. Most importantly

Table 1: Summary of clinical presentations and progress
Associated symptoms Day of performing Day of Total length of
No. of DLS from original Time post-DLS discharge stay in ward
patients Persistent fever at POD3 Abdominal Poor Refusal to that fever settled
and temperature (°C) pain appetite mobilise surgery post-DLS (days)
1 Yes, 38.7 Yes No Yes POD3 POD-DLS 1 POD-DLS 3 6
2 Yes, 38.5 Yes No No POD4 POD-DLS 1 POD-DLS 3 7
3 Yes, 39.0 No Yes Yes POD4 POD-DLS 1 POD-DLS 3 7
4 Yes, 39.0 Yes Yes Yes POD3 POD-DLS 1 POD-DLS 3 6
5 Yes, 38.5 No No Yes POD5 POD-DLS 1 POD-DLS 2 7
6 Yes, 39.0 No No Yes POD4 POD-DLS 1 POD-DLS 2 6
7 Yes, 39.0 Yes Yes Yes POD4 POD-DLS 1 POD-DLS 2 6
DLS: delayed laparoscopic suction; POD: post-operative day; POD-DLS: post-operative day- delayed laparoscopic suction
Mini-invasive Surgery ¦ Volume 1 ¦ September 30 145