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Risk factors for intra-abdominal abscess following laparoscopic appendectomy for acute appendicitis: a retrospective cohort study on 2076 patients

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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

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

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

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.

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References

  1. 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

    CAS  PubMed  Google Scholar 

  2. 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

    Article  Google Scholar 

  3. 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

    Article  CAS  PubMed  Google Scholar 

  4. 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

    Article  PubMed  Google Scholar 

  5. Gupta R, Sample C, Bamehriz F, Birch DW (2006) Infectious complications following laparoscopic appendectomy. Can J Surg 49(6):397–400

    PubMed  PubMed Central  Google Scholar 

  6. 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

    Article  PubMed  Google Scholar 

  7. 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

    Article  PubMed  Google Scholar 

  8. 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

    Article  Google Scholar 

  9. 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

    Article  PubMed  Google Scholar 

  10. 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

    Article  CAS  PubMed  Google Scholar 

  11. 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

    Article  PubMed  Google Scholar 

  12. 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

    Article  PubMed  Google Scholar 

  13. Frazee R, Bohannon WT (1996) Laparoscopic appendectomy for complicated appendicitis. Arch Surg 131(5):509–511. https://doi.org/10.1001/archsurg.1996.01430170055010

    Article  CAS  PubMed  Google Scholar 

  14. 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

    Article  PubMed  Google Scholar 

  15. 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.

  16. 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

    Article  PubMed  Google Scholar 

  17. 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  Google Scholar 

  18. Hanssen A, Plotnikov S, Dubois R (2007) Laparoscopic appendectomy using a polymeric clip to close the appendicular stump. JSLS 11(1):59–62

    PubMed  PubMed Central  Google Scholar 

  19. 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

    Article  PubMed  Google Scholar 

  20. 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

    Article  PubMed  Google Scholar 

  21. 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

    Article  Google Scholar 

  22. 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

    Article  CAS  PubMed  Google Scholar 

  23. 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

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy

    Dario Tartaglia, Lorenzo Maria Fatucchi, Alessio Mazzoni, Lorenzo Piccini, Marsia Pucciarelli, Federico Coccolini & Massimo Chiarugi

  2. Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

    Mario Miccoli

  3. Cambridge University Hospitals, NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, UK

    Salomone Di Saverio

Authors
  1. Dario Tartaglia
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  2. Lorenzo Maria Fatucchi
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  3. Alessio Mazzoni
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  4. Mario Miccoli
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  5. Lorenzo Piccini
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  6. Marsia Pucciarelli
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  7. Salomone Di Saverio
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  8. Federico Coccolini
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  9. Massimo Chiarugi
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Dario Tartaglia, Lorenzo Maria Fatucchi, Alessio Mazzoni, Mario Miccoli, Lorenzo Piccini, Marsia Pucciarelli. The first draft of the manuscript was written by Dario Tartaglia, Lorenzo Maria Fatucchi and Alessio Mazzoni. Salomone Di Saverio, Federico Coccolini, and Massimo Chiarugi provided a critical revision of the first draft. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Dario Tartaglia.

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As observational study no ethical approval was requested by our institution.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (Institutional and National) and with the Helsinki Declaration of 1964 and later versions.

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Tartaglia, D., Fatucchi, L.M., Mazzoni, A. et al. Risk factors for intra-abdominal abscess following laparoscopic appendectomy for acute appendicitis: a retrospective cohort study on 2076 patients. Updates Surg 72, 1175–1180 (2020). https://doi.org/10.1007/s13304-020-00749-y

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  • DOI: https://doi.org/10.1007/s13304-020-00749-y

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