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Aim: Although laparoscopic appendicectomy (LA) is an accepted alternative to the open appendicectomy (OA) approach, it has been suggested that there is a higher incidence of intraabdominal abscesses (IAAs). Our aim was to determine the incidence of IAA in 3 pediatric surgical centers routinely practicing both techniques., Methods: Data were collected retrospectively for pediatric patients undergoing LA or OA over an 8-year period. Analysis included IAA formation, appendicitis complexity, radiologic/histologic investigations, grade of surgeon, and wound infection., Main Results: A total of 1267 appendicectomies were performed (514 LAs and 753 OAs). There was no difference between the incidences of IAA (LA, 3.9% [19/491] vs OA, 3.9% [28/714]; P = 1.0). The incidence of IAA was increased in those with complicated appendicitis (34/375 [9.1%] vs 13/830 [1.6%]; P ≤ .0001). There was an increased proportion of those with complicated appendicitis in the LA group (182/491 [37.1%] vs 193/714 [27.0%]; P = .0002). Surgical trainees were more likely to be the primary surgeon in the OA group (79% vs 63%; P = .0001), although the incidence of IAA did not correlate with grade of surgeon. There was no significant difference in incidence of wound infection between groups (LA, 4.6% [8/173] vs OA, 2.5% [18/377]; P = .93)., Conclusion: This large retrospective study shows that the technique of appendicectomy does not appear to affect the incidence of IAAs. Patients with complicated appendicitis are more likely to develop an IAA regardless of technique., (Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.)

Empyema thoracis remains a common thoracic problem with challenging management strategies. We analysed retrospectively 107 consecutive patients treated for empyema thoracic over a 5-year period. The majority of patients (75%) were male with a mean age of 51 years. Common presenting symptoms were cough, dyspnoea, chest pain and pyrexia. The mean duration of pre-admission symptoms was 7.5 weeks. The causes of empyema were pneumonia, malignancy, iatrogenic injury and trauma. The most frequently isolated organism was Streptococcus milleri. In 71% of patients there was an underlying systemic disorder. Forty-nine patients (46%) underwent an unsuccessful therapeutic procedure prior to admission to the surgical units. In the units, 24 patients received closed intercostal chest tube drainage, 14 of whom required further intervention. Two patients were treated with repeated thoracocentesis. The majority of patients underwent a surgical procedure in the first instance: rib resection and drainage (5), decortication (22), and more extensive procedures (9) with only two patients requiring further surgery. The mean post-operative stay was 16 days and the hospital mortality was 13%. We recommend early referral of all empyema patients to thoracic units, where assessment and definitive procedures can be performed with high chances of success and moderate risk of morbidity and mortality.