Risk factors for intra-abdominal abscess following laparoscopic appendectomy for acute appendicitis: a retrospective cohort study on 2076 patients.
Abdominal Abscess
/ epidemiology
Acute Disease
Adolescent
Adult
Appendectomy
/ methods
Appendicitis
/ surgery
Child
Cohort Studies
Female
Humans
Laparoscopy
/ methods
Male
Peritonitis
Postoperative Complications
/ epidemiology
Retrospective Studies
Risk Factors
Surgical Instruments
Treatment Outcome
Young Adult
Acute appendicitis
Appendicular stapling
Clipping mesoappendix
Laparoscopic appendectomy
Postoperative intra-abdominal abscess
Journal
Updates in surgery
ISSN: 2038-3312
Titre abrégé: Updates Surg
Pays: Italy
ID NLM: 101539818
Informations de publication
Date de publication:
Dec 2020
Dec 2020
Historique:
received:
30
11
2019
accepted:
18
03
2020
pubmed:
28
4
2020
medline:
31
12
2020
entrez:
28
4
2020
Statut:
ppublish
Résumé
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. The present study retrospectively analyzed patients undergone LA for acute appendicitis during the period 2001-2017. Clinical, intraoperative, and postoperative outcomes were described. Comparison between groups was made via univariate and multivariate analyses. The charts of 2076 patients undergone LA were reviewed. Thirty-seven patients (1.8%) developed a postoperative IAA. 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), prolonged antibiotic therapy (p < 0.05), and piperacillin/tazocin regimen (p < 0.0001) were significantly more frequent in the group of patients with IAA. In terms of multivariate analysis, only pelvic peritonitis (p = 0.010), perforated appendicitis (p = 0.0002), and clipping the mesoappendix (p = 0.0002) were independent predictive factors for postoperative IAA. 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.
Sections du résumé
BACKGROUND
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
METHODS
The present study retrospectively analyzed patients undergone LA for acute appendicitis during the period 2001-2017. Clinical, intraoperative, and postoperative outcomes were described. Comparison between groups was made via univariate and multivariate analyses.
RESULTS
RESULTS
The charts of 2076 patients undergone LA were reviewed. Thirty-seven patients (1.8%) developed a postoperative IAA. 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), prolonged antibiotic therapy (p < 0.05), and piperacillin/tazocin regimen (p < 0.0001) were significantly more frequent in the group of patients with IAA. In terms of multivariate analysis, only pelvic peritonitis (p = 0.010), perforated appendicitis (p = 0.0002), and clipping the mesoappendix (p = 0.0002) were independent predictive factors for postoperative IAA.
CONCLUSION
CONCLUSIONS
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.
Identifiants
pubmed: 32338352
doi: 10.1007/s13304-020-00749-y
pii: 10.1007/s13304-020-00749-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1175-1180Références
Coelho A, Sousa C, Marinho AS, Barbosa-Sequeira J, Recaman M, Carvalho F (2017) Post-appendectomy intra-abdominal abscesses: six years' experience in a pediatric surgery department. Cir Pediatr 30(3):152–155
pubmed: 29043693
Sauerland S, Jaschinski T, Neugebauer EA (2010) Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev 10:CD001546. https://doi.org/10.1002/14651858.CD001546.pub3
doi: 10.1002/14651858.CD001546.pub3
Horvath P, Lange J, Bachmann R, Struller F, Königsrainer A, Zdichavsky M (2017) Comparison of clinical outcome of laparoscopic versus open appendectomy for complicated appendicitis. Surg Endosc 31(1):199–205. https://doi.org/10.1007/s00464-016-4957-z
doi: 10.1007/s00464-016-4957-z
pubmed: 27194260
Soll C, Wyss P, Gelpke H, Raptis D, Breitenstein S (2016) Appendiceal stump closure using polymeric clips reduces intra-abdominal abscesses. Langenbecks Arch Surg 401(5):661–666. https://doi.org/10.1007/s00423-016-1459-3
doi: 10.1007/s00423-016-1459-3
pubmed: 27294658
Gupta R, Sample C, Bamehriz F, Birch DW (2006) Infectious complications following laparoscopic appendectomy. Can J Surg 49(6):397–400
pubmed: 17234067
pmcid: 3207540
Hartwich J, Carter R, Wolfe L, Goretsky M, Heath K, St. Peter S, et al (2013) The effects of irrigation on outcomes in cases of perforated appendicitis in children. J Surg Res 180(2):222–225. https://doi.org/10.1016/j.jss.2012.04.043
doi: 10.1016/j.jss.2012.04.043
pubmed: 22595016
Cho J, Park I, Lee D, Sung K, Baek J, Lee J (2015) Risk factors for postoperative intra-abdominal abscess after laparoscopic appendectomy: analysis for 1,817 consecutive experiences. Dig Surg 32(5):375–381. https://doi.org/10.1159/000438707
doi: 10.1159/000438707
pubmed: 26279409
Hernandez M, Finnesgard E, Aho J, Zielinski M (2017) Less is more: outcomes of postoperative organ space infection after intraoperative irrigation in appendicitis. J Am Coll Surg 225(4):S84–S85. https://doi.org/10.1016/j.jamcollsurg.2017.07.180
doi: 10.1016/j.jamcollsurg.2017.07.180
Agha RA, Borrelli MR, Vella-Baldacchino M, Thavayogan R, Orgill DP (2017) The STROCSS statement: strengthening the reporting of cohort studies in Surgery. Int J Surg 46:198–202. https://doi.org/10.1016/j.ijsu.2017.08.586
doi: 10.1016/j.ijsu.2017.08.586
pubmed: 28890409
Krisher S, Browne A, Dibbins A, Tkacz N, Curci M (2001) Intra-abdominal abscess after laparoscopic appendectomy for perforated appendicitis. Arch Surg 136(4):438–441. https://doi.org/10.1001/archsurg.136.4.438
doi: 10.1001/archsurg.136.4.438
pubmed: 11296116
Levin D, Pegoli W (2015) (2015) Abscess after appendectomy: predisposing factors. Adv Surg 49:263–280. https://doi.org/10.1016/j.yasu.2015.03.010
doi: 10.1016/j.yasu.2015.03.010
pubmed: 26299504
Reid F, Choi J, Williams M, Chan S (2017) Prospective evaluation of the Sunshine Appendicitis Grading System score. ANZ J Surg 87(5):368–371. https://doi.org/10.1111/ans.13271
doi: 10.1111/ans.13271
pubmed: 26333132
Frazee R, Bohannon WT (1996) Laparoscopic appendectomy for complicated appendicitis. Arch Surg 131(5):509–511. https://doi.org/10.1001/archsurg.1996.01430170055010
doi: 10.1001/archsurg.1996.01430170055010
pubmed: 8624197
Schlottmann F, Sadava E, Peña M, Rotholtz N (2017) Laparoscopic appendectomy: risk factors for postoperative intraabdominal abscess. World J Surg 41(5):1254–1258. https://doi.org/10.1007/s00268-017-3869-y
doi: 10.1007/s00268-017-3869-y
pubmed: 28074278
Sartelli M, Abu-Zidan FM, Catena F, Griffiths EA, Di Saverio S, Coimbra R, Ordoñez CA, Leppaniemi A, Fraga GP, Coccolini F, Agresta F,Abbas A, Abdel Kader S, Agboola J, Amhed A, Ajibade A, Akkucuk S, Alharthi B, Anyfantakis D, Augustin G, Baiocchi G, Bala M,Baraket O, Bayrak S, Bellanova G, Beltràn MA, Bini R, Boal M, Borodach AV, Bouliaris K, Branger F, Brunelli D, Catani M, Che Jusoh A, Chichom-Mefire A, Cocorullo G, Colak E, Costa D, Costa S, Cui Y, Curca GL, Curry T, Das K, Delibegovic S, Demetrashvili Z, Di Carlo I, Drozdova N, El Zalabany T, Enani MA, Faro M, Gachabayov M, Giménez Maurel T, Gkiokas G, Gomes CA, Gonsaga RA,Guercioni G, Guner A, Gupta S, Gutierrez S, Hutan M, Ioannidis O, Isik A, Izawa Y, Jain SA, Jokubauskas M, Karamarkovic A,Kauhanen S, Kaushik R, Kenig J, Khokha V, Kim JI, Kong V, Koshy R, Krasniqi A, Kshirsagar A, Kuliesius Z, Lasithiotakis K, Leão P, Lee JG, Leon M, Lizarazu Pérez A, Lohsiriwat V, López-Tomassetti Fernandez E, Lostoridis E, Mn R, Major P, Marinis A, Marrelli D, Martinez-Perez A, Marwah S, McFarlane M, Melo RB, Mesina C, Michalopoulos N, Moldovanu R, Mouaqit O, Munyika A, Negoi I,,Nikolopoulos I, Nita GE, Olaoye I, Omari A, Ossa PR, Ozkan Z, Padmakumar R, Pata F, Pereira Junior GA, Pereira J, Pintar T, Pouggouras K, Prabhu V, Rausei S, Rems M, Rios-Cruz D, Sakakushev B, Sánchez de Molina ML, Seretis C, Shelat V, Simões RL, Sinibaldi G, Skrovina M, Smirnov D, Spyropoulos C, Tepp J, Tezcaner T, Tolonen M, Torba M, Ulrych J, Uzunoglu MY, van Dellen D, van Ramshorst GH, Vasquez G, Venara A, Vereczkei A, Vettoretto N, Vlad N, Yadav SK, Yilmaz TU, Yuan KC,Zachariah SK, Zida M, Zilinskas J, Ansaloni L (2015) Global validation of the WSES Sepsis Severity Score for patients with complicated intra-abdominal infections: a prospective multicentre study (WISS Study). World J Emerg Surg 10:61. https://doi.org/10.1186/s13017-015-0055-0 .
Bhangu A, Søreide K, Di Saverio S, Assarsson J, Drake F (2015) Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet 386(10000):1278–1287. https://doi.org/10.1016/S0140-6736(15)00275-5
doi: 10.1016/S0140-6736(15)00275-5
pubmed: 26460662
Langer M, Safavi A, Skarsgard ED (2013) Management of the base of the appendix in pediatric laparoscopic appendectomy: clip, ligate, or staple? Surg Technol Int 23:81–83
pubmed: 23975448
Hanssen A, Plotnikov S, Dubois R (2007) Laparoscopic appendectomy using a polymeric clip to close the appendicular stump. JSLS 11(1):59–62
pubmed: 17651557
pmcid: 3015784
Wright GP, Mitchell EJ, McClure AM, Onesti JK, Moyo SC, Brown AR, Peshkepija A, Scott GL, Chung MH (2015) Comparison of stapling techniques and management of the mesoappendix in laparoscopic appendectomy. Surg Laparosc Endosc Percutan Tech 25(1):e11–e15. https://doi.org/10.1097/SLE.0000000000000040
doi: 10.1097/SLE.0000000000000040
pubmed: 24752160
Lee J, Hong T (2014) Comparison of various methods of mesoappendix dissection in laparoscopic appendectomy. J Laparoendosc Adv Surg Tech A. 24(1):28–31. https://doi.org/10.1089/lap.2013.0374
doi: 10.1089/lap.2013.0374
pubmed: 24206120
Kimbrell AR, Novosel TJ, Collins JN, Weireter LJ, Terzian HW, Adams RT, Beydoun HA (2014) Do postoperative antibiotics prevent abscess formation in complicated appendicitis? Am Surg. 80(9):878–883
doi: 10.1177/000313481408000921
Daskalakis K, Juhlin C, Påhlman L (2014) The use of pre- or postoperative antibiotics in surgery for appendicitis: a systematic review. Scand J Surg 103(1):14–20. https://doi.org/10.1177/1457496913497433
doi: 10.1177/1457496913497433
pubmed: 24056131
Anderson K, Bartz-Kurycki M, Kawaguchi A, Austin M, Holzmann-Pazgal G, Kao L et al (2018) Home antibiotics at discharge for pediatric complicated appendicitis: friend or foe? J Am Coll Surg 227(2):247–254. https://doi.org/10.1016/j.jamcollsurg.2018.04.004
doi: 10.1016/j.jamcollsurg.2018.04.004
pubmed: 29680415