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The need for culture swabs in laparoscopically treated appendicitis
13 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
Introduction:
Appendicitis remains the most common cause of an acute abdomen. Obtaining intra-abdominal cultures is routine surgical practice. There are studies showing no efficacy of such procedures in cases where open appendectomies are performed.
Aim:
The goal of this study was to assess the need for obtaining intra-abdominal cultures during laparoscopic appendectomies.
Material And Methods:
Between 2007 and 2012, 369 patients were operated on with the diagnosis of histopathologically proven acute appendicitis. Sixty-two percent of them were operated on using laparoscopic techniques. The microbiological assessment was routinely done for the open procedures and in 42% of cases that underwent a laparoscopic operation.
Results:
In 57% (134) the swabbing results were negative. Among 43% (102) of the patients with a positive result, Escherichia coli was isolated in 76.5% (78), Proteus mirabilis in 13.7% (14), Pseudomonas aeruginosa in 4.9% (5) and Citrobacter freundii in 4.9% (5). Five cases had bacteria resistant to the antibiotic given preoperatively (that is 4.9% of all positive cultures and 1.4% of all operated patients). However, these cases did not affect the incidence of postoperative complications. Consideration of the postoperative morbidity showed that there was no statistically significant difference between the laparoscopic group with and without intra-operative swabbing (p > 0.05).
Conclusions:
The postoperative patient outcome was more dependent on the pathology of the appendix than on the results of the microbiological assessment at the time of surgery. Hence, routine intra-operative cultures during laparoscopic appendectomies appear to have little value in patient management. Swabbing during laparoscopic procedures should be limited to only selected high-risk groups.
Insights
Routine intra-abdominal cultures during laparoscopic appendectomies offer little benefit. Patient outcomes depend more on appendix pathology, suggesting cultures should be reserved for high-risk cases.
Area of Science:
- General Surgery
- Surgical Microbiology
Background:
- Appendicitis is a common cause of acute abdomen, with intra-abdominal cultures a routine surgical practice.
- Previous studies suggest limited efficacy of intra-abdominal cultures in open appendectomies.
Purpose of the Study:
- To evaluate the necessity of intra-abdominal cultures during laparoscopic appendectomies.
Main Methods:
- A retrospective analysis of 369 patients with acute appendicitis between 2007 and 2012.
- Laparoscopic appendectomy was performed in 62% of cases.
- Intra-abdominal cultures were obtained in all open procedures and 42% of laparoscopic procedures.
Main Results:
- Negative culture results were observed in 57% of patients.
- Commonly isolated bacteria included Escherichia coli (76.5%), Proteus mirabilis (13.7%), Pseudomonas aeruginosa (4.9%), and Citrobacter freundii (4.9%).
- No statistically significant difference in postoperative morbidity was found between laparoscopic groups with and without intra-operative cultures (p > 0.05).
Conclusions:
- Postoperative outcomes are primarily influenced by appendix pathology, not microbiological findings.
- Routine intra-operative cultures in laparoscopic appendectomies provide minimal value for patient management.
- Intra-operative swabbing should be reserved for selected high-risk patient groups.
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