Is laparoscopic approach still a risk factor for postappendectomy intra-abdominal abscess?

Abstract

BACKGROUND The impact of laparoscopic appendectomy (LA) on the incidence of intra-abdominal abscess (IAA) remains controversial. We aimed to identify risk factors for postappendectomy IAA and assess the impact of appendectomy approach in postoperative morbidity. METHODS A retrospective single-center study including consecutive patients who underwent appendectomy for acute appendicitis between 2015 and 2018 was performed. Demographic, clinical, intraoperative, and perioperative variables were collected. Univariate and multivariate analyses was performed to detect independent risk factors for IAA. Comparison of LA and open appendectomy was conducted, and propensity score model (PSM) was used to overcome differences between groups. Independent risk factors for IAA were identified by univariate and multivariate analyses in the PSM cohort. RESULTS A total of 532 appendectomies were included. The median age was 35 years. Three hundred two patients (56.7%) underwent LA. The most frequent operative finding was American Association for the Surgery of Trauma (AAST) grade 1 appendicitis in 303 patients (57%). Peritonitis was found in 109 patients (20.5%). Postoperative morbidity and mortality were 14.4% and 0%, respectively. Intra-abdominal abscess rate was 6.2%. An AAST grade of ≥2, a preoperative C-reactive protein level of >100 mg/dL, and diabetes mellitus were identified as independent risk factors for IAA in the multivariate analysis. Comparing LA and open appendectomy, there were no differences in IAA rates. After PSM, LA showed lower morbidity and shorter hospital stay. CONCLUSIONS Laparoscopic appendectomy is a safe approach and not related to a higher risk of IAA. Patients with an AAST grade of ≥2, a preoperative C-reactive protein level of >100, and diabetes mellitus have higher risk for postappendectomy IAA. LEVEL OF EVIDENCE Therapeutic/care management, level IV.

The necessity of abdominal drainage for patients with complicated appendicitis undergoing laparoscopic appendectomy: a retrospective cohort study

“…In our study, the frequency of IAA formation in complicated appendicitis (2.9%) was lower than that reported in previous studies[ 7 , 8 ] and comparable to that reported in one study [ 17 ]. Most IAAs could be controlled with intravenous antibiotics and did not require postoperative surgical drainage for the IAA.…”

“…A literature review revealed that most retrospective studies did not detail how they determined a patient’s AAST grade [ 13 , 17 ]. During the process of classifying the AAST grade of each patient in our study, ambiguity in the descriptions of surgical findings in operation notes was encountered and became one particular challenge.…”

Laparoscopic Versus Open Appendectomy for Patients With Perforated Appendicitis

“…Fernández-Moreno MC et al demonstrated that laparoscopic appendectomy is not associated with greater risk of IAA. The risk factors for IAA involve factors relating to poorer immune functioning (i.e., diabetes mellitus) and more profound infection (i.e., high creactive protein (CRP)) [18]. Thus, IAA may be independent of laparoscopic appendectomy.…”

Risk factors for prolonged hospitalization and delayed treatment completion after laparoscopic appendectomy in patients with uncomplicated acute appendicitis

“…Despite advances in antibiotic management, appendectomy is generally regarded as the treatment of choice for acute appendicitis [2]. In addition, laparoscopic appendectomy has been the gold standard treatment for acute appendicitis, especially in high-income countries [3], because of advantages such as shorter length of hospital stay (LOS), less postoperative pain, earlier postoperative recovery, lower complication rate, and better cosmetic results compared to conventional open appendectomy [4][5][6].…”