Effectiveness of the short antibiotics prophylaxis in transumbilical laparoscopic-assisted appendectomy for uncomplicated appendicitis

Aim of the Study: To determine effectiveness of short-term antibiotics therapy in management of acute appendicitis in children. Methods: Retrospective review of 120 consecutive patients operated of appendectomy with transumbilical laparoscopic assisted appendectomy (TULAA) technique for uncomplicated appendicitis. 26 patients were excluded due to conversion. Patients were divided into two groups: children who received only a preoperative dose of antibiotic (Group A – Short) vs children who received both preoperative and postoperative doses of antibiotics (Group B – Long). In both groups surgical time (ST), length of stay (LS), short and middle-term post-operative complications (PC) were evaluated. Main results: 94 children (Group A 31, Group B 63); mean age 10 y.o. High prevalence of male in group A (Fisher Test 0.069). Adherences of the appendix were present in 38% group A vs 54% in group B. Mean ST (min): 51 group A vs 57 group B (p=0.05092). Mean LS: 4 days in both groups. PC: 1 patient in group A vs 2 patients in group B showed surgical incision infection. No infective abdominal collections in all patients at mid-term follow up (ultrasound control). Conclusions: Conclusive demonstration of effectiveness of the short prophylaxis in TULAA uncomplicated appendectomy would need a randomized controlled trial: these preliminary data point to a similar efficacy of the two strategies. In view of the increasing risk of antimicrobial resistance, the short-term strategy represents an efficacious option. Interestingly, appendicitis in female seems to lead surgeon to a more aggressive long-term antibiotic strategy.