ANNSURG-D-15-01295; Total nos of Pages: 1;
ANNSURG-D-15-01295
Reply to Letter:
‘‘Laparoscopic Surgery or
Conservative Treatment
for Appendiceal Abscess in
Adults?’’
Reply:
W e appreciate the comments presented
by Weber and Di Saverio. As they
pointed out, our study’s outcome may not
be generalized in every patient in every
clinical setting. Laparoscopic surgery for
appendiceal abscess requires experience
and skills. With limited experience, compli-
cation rate and conversion rate are likely
higher than the rates presented in our study.
However, appendiceal abscess is hardly ever
Copyright ß 2015 Wolters Kluwer Health, Inc. All
rights reserved.
ISSN: 0003-4932/14/26105-0821
DOI: 10.1097/SLA.0000000000001495
Annals of Surgery  Volume XX, Number X, Month 2015
Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
RESPONSE TO LETTER
such surgical emergency that needs to be
operated on out of regular working hours,
when limited surgical experience is available.
Therefore, we recommend that surgery for
appendiceal abscess should be postponed
until an experienced surgeon is available for
the patient. In our institution we have utilized
traffic-light coding system to organize emer-
gency surgery. Using this system only the most
urgent operations (red code) are allowed
during the nighttime. Appendiceal abscesses
are classified as orange code allowing maxi-
mum delay of 24 hours. These patients are
operated on by surgeons dedicated to acute
general surgery, mainly during daytime.
On the other hand, we believe that neither
obesity nor advanced age should indicate con-
servative management. Nearly a quarter of
patients in our study were obese [body mass
index (BMI) > 30 kg/m2] and they recovered as
well as nonobese patients. Nonoperative treat-
ment with percutaneous drainage is still an
option for patients unfit for surgery or when
an experienced laparoscopic surgeon is not avail-
able. Unfortunately, the anatomical site of
abscess may limit the use of percutaneous drain-
age. If abscess is not accessible for drainage, the
risk for treatment failure is substantially high.
Panu Mentula, MD, PhD
Department of Abdominal Surgery
Helsinki University Central Hospital
Helsinki, Finland
panu.mentula@hus.fi
Henna Sammalkorpi, MD
Ari Leppäniemi, MD, PhD
Department of Abdominal Surgery
Helsinki University Central Hospital
Helsinki, Finland
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