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ANNSURG-D-15-01295; Total nos of Pages: 1;

ANNSURG-D-15-01295

RESPONSE TO LETTER

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

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ISSN: 0003-4932/14/26105-0821
DOI: 10.1097/SLA.0000000000001495

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Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.