Laparoscopic Appendectomy: Risk Factors for Postoperative Intraabdominal Abscess

Laparoscopic appendectomy (LA) has obtained wide acceptance over the last two decades. However, some studies suggest that there is an increased rate of intraabdominal abscess (IAA) when is compared with open appendectomy. Since postoperative IAA is associated with high morbidity, identifying predictive factors of this complication may help to prevent it. The aim of this study was to identify preoperative and intraoperative risk factors for IAA after LA.

From January 2005 to June 2015, all charts of consecutive patients underwent to LA were revised. Demographics, clinical and intraoperative variables were analyzed. Independent risk factors for postoperative IAA were determined by logistic regression analysis.

A total of 1300 LA were performed. The mean age was 34.7 (14-94) years. Two hundred and twenty-five patients (17.3%) had complicated appendicitis with perforation and peritonitis. The conversion rate was 2.3% (30 cases). The average hospital stay was 1.6 (0-27) days. There were 30 (2.3%) postoperative IAA. In the multivariate analysis, body mass index (BMI) >30 (p 0.01), leukocytosis >20,000/mm³ (p 0.02), perforated appendicitis (p < 0.001) and operative time >90 min (p 0.04) were associated with the development of postoperative IAA. There was no mortality in the series.

Patients with obesity, leukocytosis >20,000/mm³, perforated appendicitis and surgical time longer than 90 min have a higher chance of having a postoperative IAA. A close postoperative follow-up would be necessary in these situations in order to prevent and identify IAA after LA.