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Is laparoscopic approach still a risk factor for postappendectomy intra-abdominal abscess?
María-Carmen Fernández-Moreno1, Leticia Pérez Santiago, Rosa Martí Fernández
1From the Department of Surgery (M.-C.F.-M., L.P.S., R.M.F., C.L.E., J.O.S.), Hospital Clínico Universitario de Valencia; and Biomedical Research Institute (INCLIVA) (J.O.S.), University of Valencia, Valencia, Spain.
Background:
The impact of laparoscopic appendectomy (LA) on the incidence of intra-abdominal abscess (IAA) remains controversial. We aimed to identify risk factors for postappendectomy IAA and assess the impact of appendectomy approach in postoperative morbidity.
Methods:
A retrospective single-center study including consecutive patients who underwent appendectomy for acute appendicitis between 2015 and 2018 was performed. Demographic, clinical, intraoperative, and perioperative variables were collected. Univariate and multivariate analyses was performed to detect independent risk factors for IAA. Comparison of LA and open appendectomy was conducted, and propensity score model (PSM) was used to overcome differences between groups. Independent risk factors for IAA were identified by univariate and multivariate analyses in the PSM cohort.
Results:
A total of 532 appendectomies were included. The median age was 35 years. Three hundred two patients (56.7%) underwent LA. The most frequent operative finding was American Association for the Surgery of Trauma (AAST) grade 1 appendicitis in 303 patients (57%). Peritonitis was found in 109 patients (20.5%). Postoperative morbidity and mortality were 14.4% and 0%, respectively. Intra-abdominal abscess rate was 6.2%. An AAST grade of ≥2, a preoperative C-reactive protein level of >100 mg/dL, and diabetes mellitus were identified as independent risk factors for IAA in the multivariate analysis. Comparing LA and open appendectomy, there were no differences in IAA rates. After PSM, LA showed lower morbidity and shorter hospital stay.
Conclusions:
Laparoscopic appendectomy is a safe approach and not related to a higher risk of IAA. Patients with an AAST grade of ≥2, a preoperative C-reactive protein level of >100, and diabetes mellitus have higher risk for postappendectomy IAA.
Level Of Evidence:
Therapeutic/care management, level IV.
Insights
Laparoscopic appendectomy (LA) does not increase the risk of intra-abdominal abscess (IAA). Higher AAST grade, elevated C-reactive protein, and diabetes are key risk factors for post-appendectomy IAA.
Area of Science:
- Surgical outcomes
- Gastrointestinal surgery
- Infectious disease complications
Background:
- The incidence of intra-abdominal abscess (IAA) following laparoscopic appendectomy (LA) is debated.
- Identifying risk factors for post-appendectomy IAA is crucial for patient management.
Purpose of the Study:
- To determine risk factors for post-appendectomy IAA.
- To compare the postoperative morbidity of LA versus open appendectomy.
Main Methods:
- Retrospective single-center study of 532 patients undergoing appendectomy for acute appendicitis (2015-2018).
- Analysis included demographic, clinical, and operative variables.
- Propensity score modeling (PSM) was used to compare LA and open appendectomy groups.
Main Results:
- The overall IAA rate was 6.2%.
- Independent risk factors for IAA included AAST grade ≥2, C-reactive protein >100 mg/dL, and diabetes mellitus.
- Laparoscopic appendectomy (LA) demonstrated lower postoperative morbidity and shorter hospital stay compared to open appendectomy after PSM.
Conclusions:
- Laparoscopic appendectomy (LA) is a safe and effective approach for appendicitis, not associated with increased IAA risk.
- Specific patient factors (high AAST grade, elevated CRP, diabetes) predict higher IAA risk.
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