Early laparoscopic appendectomy for appendicular mass

Background: The surgical management of acute appendicitis presenting with appendicular mass remains controversial. The aim of this study was to evaluate the role of early laparoscopy and laparoscopic appendectomy (LA) in the management of appendicular mass. Methods: During a 1-year period, 62 patients underwent LA for suspected appendicitis (n = 50), generalized peritonitis (n = 2), and an appendicular mass (n = 10). Another patient who presented with an appendicular mass was found at laparoscopy to have an ileo-ileal intussusception. Results: All appendectomies were attempted and completed laparoscopically. Postoperative complications occurred in two patients; there were no deaths. None of the patients treated for an appendicular mass developed complications. There was no difference between the patients who underwent LA during the index admission for an appendicular mass and those who had surgery for non-mass-forming appendices with regard to the operative time (median [interquartile range]: 45 [36-60] vs 40 [25-50] min, p = 0.085) and postoperative hospital stay (median [interquartile range]: 2 [1-2] vs [1-2] days, P = 0.1). Conclusion: Early LA during the index admission of patients with an appendicular mass is feasible and safe, obviates the need for a second hospital admission, and avoids misdiagnoses.