Risk Factors for Postoperative Intra-Abdominal Abscess after Laparoscopic Appendectomy: Analysis for Consecutive 1,817 Experiences

Abstract

Background: Possible risk factors for postoperative intra-abdominal abscess (IAA) formation after laparoscopic appendectomy (LA) remain controversial. A perforated appendicitis, diabetes mellitus, peritoneal irrigation, obesity and age are considered to be possible risk factors for postoperative IAA, but the existing evidence is insufficient. This study aimed to identify the risk factors for IAA formation in patients receiving LA. Methods: Between January 2010 and December 2013, 1,817 patients who underwent 3-port LA were enrolled in this study. Patients were classified into 2 groups according to the development of postoperative IAA, and the differences between the groups were analyzed. Results: The incidence of IAA after LA was 1.5%, and the only identified risk factor for IAA was peritoneal irrigation. On logistic regression analysis of those patients who received peritoneal irrigation, suppurative appendicitis and non-placement of the peritoneal drain were found to be significant risk factors for the development of IAA. Conclusions: Peritoneal irrigation in a case of abdomen contamination was shown to be a risk factor for the development of postoperative IAA after LA. When peritoneal irrigation is performed, surgeons should consider using peritoneal drainage and postoperative antibiotics (including anti-anaerobic antibiotics) to prevent postoperative IAA formation.

Clinical implication of discrepancies between surgical and pathologic diagnoses of acute appendicitis

“…Previously, it has been reported that a surgical grading system [8] or the intraoperative diagnosis [6910] could predict the development of postoperative infectious complications; however, no recent studies have demonstrated these features in the pathologic diagnosis. As we reported in our recent article [5], the surgical diagnosis of appendicitis alone seems inappropriate for predicting the development of postappendectomy IAA. Rather, the adequacy of intraoperative infectious source control and postoperative antimicrobial treatment were more predictive of the outcome than the gross morphology of appendicitis itself [11].…”

“…The details of our protocol have been previously reported [5]. Briefly, appendicitis was diagnosed on the basis of the patients' medical history, physical examinations, and radiological findings.…”

“…On the basis of our previous research [5] and other literature reports, we selected clinical variables, from the medical records, that could estimate the severity of appendicitis and the intensity of the treatment pathway, as follows: (1) duration of symptoms, WBC count, CRP level, presence of diabetes mellitus (DM), operation time, and incidence of postoperative intraabdominal abscess (IAA) for the severity; and (2) performance of intraoperative peritoneal irrigation or drainage and the length of postoperative antibiotics treatment for the treatment intensity. We hypothesized that an operation time could reflect disease severity because the more intraperaitoneal inflammation is severe, the more intraoperative procedures, such as removal of remaining abscess and phlegmon, peritoneal irrigation, suction, cleansing procedure, and placement of peritoneal drainage, would be required.…”

Variation in anti‐microbial prescription and complications post emergency appendicectomy in Australia: do we follow recommended guidelines?

“…The highest predictors of post‐operative SSI were seen in individuals who had an open operation, and those who identified as ATSI. Evidence from multiple studies has demonstrated higher rates of SSI in patients who have an open compared to laparoscopic appendicectomy . Further subgroup analysis in our patient population showed that 69% of the converted to open cases were associated with complicated appendicitis.…”

Unusual case of rapid growing intraabdominal abscess caused by Stenotrophomonas maltophilia after laparoscopic appendectomy due to perforated appendicitis

“…[6] The same study reported that the risk factors for intraabdominal abscess formation after laparoscopic appendectomy were peritoneal irrigation and nonplacement of a peritoneal drain. [6] In the present case, peritoneal irrigation (about 100cc) was performed during the laparoscopic appendectomy, and a peritoneal drain was inserted. In the present case, a small intraabdominal abscess was detected in the ileocecum area 2 weeks after the laparoscopic appendectomy was performed for perforated appendicitis.…”