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Antibiotic Therapy Versus Percutaneous Drainage for Postoperative Intra-abdominal Abscess Measuring 2 to 4 cm After
Juan J Baz Gallego1, María A Casas1, Jorge N Rodríguez Piñero1
1Department of Surgery, Hospital Alemán, Buenos Aires, Argentina.
Background:
Postoperative intra-abdominal abscess (IAA) is the most feared complication after laparoscopic appendectomy (LA). The management of IAA measuring 2 to 4 cm remains controversial. We aimed to compare the effectiveness of antibiotic treatment versus percutaneous drainage for the treatment of IAA measuring 2 to 4 cm following LA.
Methods:
A consecutive series of patients with post-appendectomy IAA measuring 2 to 4 cm from January 2006 to April 2024 was included for analysis. The patient cohort was divided into 2 groups according to the treatment modality: antibiotic therapy alone (ATB) versus computed tomography-guided percutaneous drainage (PERC). The primary outcome was to compare the success rate between groups. Secondary endpoints included overall and major complications, length of stay (LOS), readmissions, and mortality.
Results:
During the study period, 2700 LA were performed, and 123 (4.5%) patients developed an IAA. Of these, 47 (38%) measured 2 to 4 cm: 25 (53%) received antibiotics only (ATB), and 22 (47%) underwent percutaneous drainage (PERC). The success rates were comparable between groups (ATB: 92% vs. PERC: 95.4%, P=0.6). Patients who failed conservative management in both groups underwent laparoscopic lavage without further complications. No readmissions, morbidity or mortality were observed. The mean LOS was longer in the PERC group (ATB: 2.0 vs. PERC: 3.5 d, P=0.03).
Conclusions:
Antibiotic therapy and percutaneous drainage are both highly effective for treating IAA measuring 2 to 4 cm following LA. Given the less invasive nature of antibiotic therapy with shorter length of stay, it should be considered the initial treatment of choice.
Insights
Antibiotic therapy and percutaneous drainage are effective for treating intra-abdominal abscesses after laparoscopic appendectomy. Antibiotic therapy is recommended as the initial treatment due to its less invasive nature and shorter hospital stay.
Area of Science:
- Gastroenterology
- Surgical Complications
- Infectious Diseases
Background:
- Intra-abdominal abscess (IAA) is a significant complication following laparoscopic appendectomy (LA).
- Management of small (2-4 cm) post-LA IAA is debated.
- This study compares antibiotic therapy versus percutaneous drainage for small IAA.
Purpose of the Study:
- To compare the effectiveness of antibiotic therapy (ATB) versus percutaneous drainage (PERC) for treating 2-4 cm IAA after LA.
- To evaluate success rates, complications, length of stay, readmissions, and mortality.
Main Methods:
- Retrospective analysis of 47 patients with 2-4 cm post-LA IAA (Jan 2006-Apr 2024).
- Patients treated with ATB (n=25) or computed tomography-guided PERC (n=22).
- Primary outcome: treatment success rate. Secondary outcomes: complications, length of stay, readmissions, mortality.
Main Results:
- Success rates were similar: ATB 92% vs. PERC 95.4% (P=0.6).
- No significant differences in overall complications, readmissions, or mortality.
- Mean length of stay was shorter for ATB (2.0 days) vs. PERC (3.5 days) (P=0.03).
Conclusions:
- Both ATB and PERC are highly effective for managing 2-4 cm IAA post-LA.
- ATB is recommended as the initial treatment due to its minimally invasive nature and shorter length of stay.
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