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Usefulness of intraoperative culture swabs in laparoscopic appendectomy for complicated appendicitis

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Abstract

Purpose

Intraabdominal abscess (IAA) is a feared complication after laparoscopic appendectomy (LA) for complicated appendicitis. Benefits of obtaining intraoperative culture swabs (ICS) still remain controversial. We aimed to determine whether ICS modify the rate and management of IAA after LA for complicated appendicitis.

Methods

A consecutive series of patients who underwent LA for complicated appendicitis from 2008 to 2018 were included. The cohort was divided into two groups: group 1 (G1), with ICS, and group 2 (G2), without ICS. Demographics, operative variables, pathogen isolation, antibiotic sensitivity, and postoperative outcomes were analyzed.

Results

A total of 1639 LA were performed in the study period. Of these, 270 (16.5%) were complicated appendicitis; 90 (33%) belonged to G1 and 180 (67%) to G2. In G1, a higher proportion of patients had generalized peritonitis (G1, 63.3%; G2, 35%; p < 0.01). Seventy-two (80%) patients had positive cultures in G1. The most frequently isolated bacteria were E. coli (66.7%), Bacteroides spp. (34.7%), and Streptococcus spp. (19.4%). In 26 (36%) patients, the initial empiric antibiotic course was modified due to bacterial resistance. The rate of IAA was higher in patients with ICS (G1, 21.1%; G2, 9.4%; p = 0.01). IAA was treated similarly in both groups. A different type of bacteria was isolated in 7 (53.8%) patients with new culture swabs.

Conclusions

Obtaining ICS in LA for complicated appendicitis with further antibiotic adjustment to the initial pathogen did not lower the incidence of postoperative IAA and did not modify the treatment needed for this complication.

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Authors and Affiliations

  1. Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredón 1640, C1118AAT, Buenos Aires, Argentina

    María E. Peña, Emmanuel E. Sadava, Francisco Laxague & Francisco Schlottmann

Authors
  1. María E. Peña
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  2. Emmanuel E. Sadava
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  3. Francisco Laxague
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  4. Francisco Schlottmann
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by María Elena Peña, Emmanuel E. Sadava, Francisco Laxague, and Francisco Schlottmann. The first draft of the manuscript was written by María Elena Peña and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to María E. Peña.

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The authors declare that they have no conflict of interest.

Ethics approval

Ethical approval was waived by the Institutional Review Board of our Institution in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

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Peña, M.E., Sadava, E.E., Laxague, F. et al. Usefulness of intraoperative culture swabs in laparoscopic appendectomy for complicated appendicitis. Langenbecks Arch Surg 405, 691–695 (2020). https://doi.org/10.1007/s00423-020-01913-z

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  • DOI: https://doi.org/10.1007/s00423-020-01913-z

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