Schlottmann Francisco, Sadava Emmanuel E, Peña M E, Rotholtz Nicolás A
Department of General Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredón 1640 (ATT 1118), Buenos Aires, Argentina.
World J Surg. 2017 May;41(5):1254-1258. doi: 10.1007/s00268-017-3869-y.
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/mm (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/mm, 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.
在过去二十年中，腹腔镜阑尾切除术（LA）已获得广泛认可。然而，一些研究表明，与开腹阑尾切除术相比，LA术后腹腔内脓肿（IAA）的发生率有所增加。由于术后IAA与高发病率相关，识别该并发症的预测因素可能有助于预防它。本研究的目的是确定LA术后IAA的术前和术中危险因素。
回顾2005年1月至2015年6月期间所有接受LA的连续患者的病历。分析人口统计学、临床和术中变量。通过逻辑回归分析确定术后IAA的独立危险因素。
共进行了1300例LA手术。平均年龄为34.7岁（14 - 94岁）。225例患者（17.3%）患有复杂阑尾炎伴穿孔和腹膜炎。中转开腹率为2.3%（共30例）。平均住院时间为1.6天（0 - 27天）。术后发生IAA的有30例（2.3%）。在多因素分析中，体重指数（BMI）>30（p = 0.01）、白细胞增多>20,000/mm³（p = 0.02）、穿孔性阑尾炎（p < 0.001）和手术时间>90分钟（p = 0.04）与术后IAA的发生相关。该系列中无死亡病例。
肥胖、白细胞增多>20,000/mm³、穿孔性阑尾炎以及手术时间超过90分钟的患者术后发生IAA的几率更高。在这些情况下，术后密切随访对于预防和识别LA术后的IAA是必要的。
