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Usefulness of intraoperative culture swabs in laparoscopic appendectomy for complicated appendicitis

María E Peña1, Emmanuel E Sadava2, Francisco Laxague2

  • 1Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredón 1640, C1118AAT, Buenos Aires, Argentina. mpena@hospitalaleman.com.

Langenbeck'S Archives of Surgery
|June 28, 2020
PubMed
Abstract

Insights

Obtaining intraoperative culture swabs during laparoscopic appendectomy for complicated appendicitis did not reduce the rate of intraabdominal abscesses. Adjusting antibiotics based on these cultures also did not alter the management of this complication.

Area of Science:

  • Surgical infections
  • Microbiology
  • Gastrointestinal surgery

Background:

  • Intraabdominal abscess (IAA) is a significant complication following laparoscopic appendectomy (LA) for complicated appendicitis.
  • The utility of intraoperative culture swabs (ICS) in modifying IAA rates and management remains debated.

Purpose of the Study:

  • To investigate whether obtaining ICS impacts the incidence and management of IAA after LA for complicated appendicitis.
  • To analyze the influence of ICS on antibiotic selection and postoperative outcomes.

Main Methods:

  • A retrospective analysis of 270 patients undergoing LA for complicated appendicitis between 2008 and 2018.
  • Patients were divided into two groups: those with ICS (G1) and those without ICS (G2).
  • Demographic, operative, microbiological, and outcome data were compared between groups.

Main Results:

  • The rate of IAA was significantly higher in the ICS group (21.1%) compared to the non-ICS group (9.4%).
  • Positive cultures were obtained in 80% of the ICS group, with E. coli being the most common pathogen.
  • Antibiotic regimens were modified in 36% of patients due to resistance, but IAA treatment was similar across both groups.

Conclusions:

  • Intraoperative culture swabs in LA for complicated appendicitis do not decrease the incidence of postoperative IAA.
  • Antibiotic adjustments based on ICS findings did not alter the treatment approach for IAA.
  • The routine use of ICS in this setting may not be beneficial and could be associated with a higher IAA rate.
Keywords:
Complicated appendicitisCulture swabsIntraabdominal abscessLaparoscopic appendectomy

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