Rodríguez Piñero Jorge Nicolás, Casas María A, Angeramo Cristian A, Baz Gallego Juan José, Laxague Francisco, Schlottmann Francisco
Department of Surgery, Hospital Alemán, Av. Pueyrredón 1640, C1118AAT, Buenos AiresBuenos Aires, Argentina.
Department of Interventional Radiology, Hospital Alemán, Buenos Aires, Argentina.
Surg Endosc. 2025 Aug;39(8):4929-4934. doi: 10.1007/s00464-025-11908-w. Epub 2025 Jun 25.
Our center has previously proposed a therapeutic algorithm for the management of intra-abdominal abscess (IAA) after laparoscopic appendectomy (LA), based on the size and number of fluid collections. The aim of this study was to prospectively determine the safety and effectiveness of this algorithm.
A prospective cohort of patients with IAA after LA from January 2019 to May 2024 was analyzed. Patients' treatment was defined based on size and number of collections: antibiotics only (ATB) for IAA smaller than 4 cm, percutaneous drainage (PERC) for IAA between 4 and 8 cm; and laparoscopic lavage and drainage (SURG) for multiple IAA and/or IAA larger than 8 cm. The primary outcome of the study was the success rate of each therapy (i.e., complete resolution of symptoms without the need for additional intervention). Secondary outcomes included length of hospital stay, major morbidity, mortality, and readmissions.
During the study period, 1000 LA were performed; 41 (4.1%) patients developed IAA and were treated according to the proposed algorithm. The mean time elapsed for IAA development was 7 (4-17) days. The most common symptoms were fever (80.4%) and abdominal pain (73.1%). Fifteen (36.5%) patients received intravenous antibiotics, 22 patients (53.6%) underwent percutaneous drainage, and 4 (9.7%) were treated with laparoscopic lavage. For the ATB Group, the success rate was 93.3%. The only patient who failed medical therapy required percutaneous drainage. The success rate for the PERC and SURG Groups was 100%. The median LOS was 2.0 (1-6) days, 3.5 (2-6) days, and 6 (4-8) days for the ATB, PERC and SURG groups, respectively (p < 0.05). No major morbidity or mortality was observed in the entire cohort.
A therapeutic algorithm for IAA after LA based on the size and number of fluid collections is safe and effective in the vast majority of patients.
我们中心此前基于积液的大小和数量，提出了一种用于腹腔镜阑尾切除术后腹腔内脓肿（IAA）管理的治疗算法。本研究的目的是前瞻性地确定该算法的安全性和有效性。
对2019年1月至2024年5月期间腹腔镜阑尾切除术后发生IAA的患者进行前瞻性队列分析。根据积液的大小和数量确定患者的治疗方案：对于小于4 cm的IAA仅使用抗生素（ATB）治疗；对于4至8 cm的IAA进行经皮引流（PERC）；对于多发IAA和/或大于8 cm的IAA进行腹腔镜灌洗引流（SURG）。本研究的主要结局是每种治疗方法的成功率（即症状完全缓解且无需额外干预）。次要结局包括住院时间、严重并发症、死亡率和再入院率。
在研究期间，共进行了1000例腹腔镜阑尾切除术；41例（4.1%）患者发生IAA，并根据所提出的算法进行治疗。IAA发生的平均时间为7（4 - 17）天。最常见的症状是发热（80.4%）和腹痛（73.1%）。15例（36.5%）患者接受了静脉抗生素治疗，22例（53.6%）患者接受了经皮引流，4例（9.7%）患者接受了腹腔镜灌洗治疗。ATB组的成功率为93.3%。唯一治疗失败的患者需要进行经皮引流。PERC组和SURG组的成功率为100%。ATB组、PERC组和SURG组的中位住院时间分别为2.0（1 - 6）天、3.5（2 - 6）天和6（4 - 8）天（p < 0.05）。整个队列中未观察到严重并发症或死亡。
基于积液大小和数量的腹腔镜阑尾切除术后IAA治疗算法在绝大多数患者中是安全有效的。
