Prevention of intra-abdominal abscess following laparoscopic appendicectomy for perforated appendicitis: A prospective study

Abstract

Perforated appendicitis can be managed effectively and safely using a laparoscopic technique. Timing of intervention and operative technique which includes four abdominal quadrants copious irrigation is important to prevent postoperative intra-abdominal abscesses.

Pelvic sepsis following laparoscopic appendicectomy versus open appendicectomy: a retrospective study of 648 cases

“…This has been demonstrated for appendicectomies in a number of studies. 8,12,[14][15][16][17][18][19][20][21] The development of pelvic sepsis following appendicectomy is an infrequent but serious complication and can be associated with significant morbidity as well as a second operative procedure, as reported by Krukowski et al 24 Jan et al 20 reports the development of pelvic collections within a week of operative procedure, 20 this is consistent with the timeframe employed in this study. The current literature demonstrates conflicting evidence with some studies suggesting that LA is associated with a higher risk of developing pelvic sepsis, 13,14,18,22 and other studies concluding that this is not significant.…”

“…Our laparoscopic procedure employed irrigation, especially in cases with complicated appendicitis, which if consistent with the current literature should have allowed demonstration of a higher rate of pelvic sepsis in LA. A previous study by Hussain et al 15 also demonstrated a decreased rate of pelvic sepsis following copious washout of all four abdominal quadrants using a 3L saline wash. 15 An interesting finding of note in our study is the anatomical distribution of the collections. The majority of collections were found in the RIF, pelvis and right paracolic gutter, this does not support the mechanism of possible diffusion that has been mentioned in the literature to date.…”

“…9 Since that time the advantages of the laparoscopic technique have been well demonstrated and Laparoscopic Appendicectomy (LA) has become the preferred procedure over OA in hospitals worldwide. [10][11][12][13][14][15] Advantages of LA include reduced postoperative pain and cosmesis. 8,12,[14][15][16][17][18][19][20][21] Despite the popularity of LA, it is still a controversial subject and some studies demonstrate a preference towards OA.…”

Comparison of Surgical Infection and Readmission Rates after Laparoscopy in Pediatric Complicated Appendicitis

“…In small children, due to the small working space and relatively low abdominal gas pressure the suction during laparoscopy frequently collapses the abdominal cavity, leading to nonvisualization of the abdominal cavity. Some authors suggested copious irrigation of four quadrants and interloop areas with at least 3 L of sterile saline, leaving 300 to 500 mL of saline inside the peritoneal cavity at the end of the procedure, and also the application of a drain [14]. On the other hand, Wang et al [10] has recommended irrigation using copious amounts of fluid containing metronidazole.…”

Laparoscopic Surgery in Luminal Gastrointestinal Emergencies—a Review of Current Status

“…A retrospective study determined its inability in preventing abscess formation in complicated appendicitis [11]. Hussain et al, in their prospective study, suggested that it may be a contributory factor in abdominal contamination [12]. However, it has been suggested that laparoscopy is better for lavage due to better visualization [13], and the EAES consensus statement of 2012 favours it [8].…”