Risk factors for intra-abdominal abscess following laparoscopic appendectomy for acute appendicitis: a retrospective cohort study on 2,076 patients

Abstract

Background. Intra-abdominal abscesses (IAA) may develop after laparoscopic appendectomies (LA) for acute appendicitis. The identification of risk factors for postoperative IAA could lead to a decrease in the readmission rate and surgery redoes after LA for acute appendicitis. Materials and methods. We reviewed 2,076 patients managed via a LA for acute appendicitis between 2001 and 2017. Male gender accounted for 53.5% of patients. Mean age was 29.5 (SD ± 18.47) years. Thirty-seven patients (1.8%) developed a postoperative IAA. Comparison between groups was made via univariate and multivariate analyses. Results. Male gender (p<0.05), ASA score ≥ 2 (p<0.05), a gangrenous or perforated appendicitis (p<0.0001), abscess or pelvic peritonitis (p<0.0001), clipping the mesoappendix (p<0.0001), appendix division by mechanical stapler (p<0.05), and prolonged antibiotic therapy (p<0.01) were significantly more frequent in the group of patients with IAA. In terms of multivariate analysis, only pelvic peritonitis (p < 0.005), a perforated appendicitis (p <0.05), and clipping the mesoappendix (p < 0.0001) were independent predictive factors for postoperative IAA Conclusion. Patients with peritonitis or a perforated appendicitis, and those who had their mesoappendix clipped showed a higher likelihood of developing an IAA. At-risk patients should be provided with careful follow-up for the early detection and management of this complication.