Early Laparoscopic Washout may Resolve Persistent Intra-abdominal Infection Post-appendicectomy
Matthew G. R. Allaway
Department of Surgery, Nepean Hosptial, P. O. Box 67, 2751 Penrith, NSW, Australia
Search for more papers by this authorKristenne Clement
Department of Surgery, Nepean Hosptial, P. O. Box 67, 2751 Penrith, NSW, Australia
Search for more papers by this authorGuy D. Eslick
The Whiteley-Martin Research Centre, Clinical Sciences Building, Nepean Hospital, P. O. Box 67, 2751 Penrith, NSW, Australia
Search for more papers by this authorCorresponding Author
Michael R. Cox
- [email protected]
- +61 2 4734 2608
Department of Surgery, Nepean Hosptial, P. O. Box 67, 2751 Penrith, NSW, Australia
The Whiteley-Martin Research Centre, Clinical Sciences Building, Nepean Hospital, P. O. Box 67, 2751 Penrith, NSW, Australia
Tel.: +61 2 4734 2608, [email protected]Search for more papers by this authorMatthew G. R. Allaway
Department of Surgery, Nepean Hosptial, P. O. Box 67, 2751 Penrith, NSW, Australia
Search for more papers by this authorKristenne Clement
Department of Surgery, Nepean Hosptial, P. O. Box 67, 2751 Penrith, NSW, Australia
Search for more papers by this authorGuy D. Eslick
The Whiteley-Martin Research Centre, Clinical Sciences Building, Nepean Hospital, P. O. Box 67, 2751 Penrith, NSW, Australia
Search for more papers by this authorCorresponding Author
Michael R. Cox
- [email protected]
- +61 2 4734 2608
Department of Surgery, Nepean Hosptial, P. O. Box 67, 2751 Penrith, NSW, Australia
The Whiteley-Martin Research Centre, Clinical Sciences Building, Nepean Hospital, P. O. Box 67, 2751 Penrith, NSW, Australia
Tel.: +61 2 4734 2608, [email protected]Search for more papers by this authorAbstract
Background
Intra-abdominal abscess (IAA) complicates 2–3% of patients having an appendicectomy. The usual management is prolonged antibiotics and drainage of the IAA. From 2006, our unit chose to use early re-laparoscopy and washout in patients with persistent sepsis following appendicectomy. The aims of this study were to assess the outcomes of early laparoscopic washout in patients with features of persistent intra-abdominal sepsis and compare those with percutaneous drainage and open drainage of post-appendicectomy IAA.
Methods
A retrospective case note review was performed for all patients having a laparoscopic washout, percutaneous drainage or open drainage following appendicectomy between January 2006 and December 2017.
Results
During the period, 4901 appendicectomies occurred. Forty-one (0.8%) patients had a laparoscopic washout, 16 (0.3%) had percutaneous drainage, and 6 (0.1%) had an open drainage. The demographics, ASA grade and pathology at initial appendicectomy were similar. The mean time after appendicectomy was significantly shorter for laparoscopic washout (4.1 days vs. 10.1 and 9.0 days, p = <0.003). The mean time for resolution of SIRS was significantly shorter (2.0 days vs. 3.3 and 5.2 days, p <0.02). The morbidity and length of stay were similar.
Conclusion
Early laparoscopic washout for persistent intra-abdominal sepsis may be an alternative to non-operative management and delayed intervention for IAA and may have better outcomes than either percutaneous drainage or open drainage. A prospective randomised comparison is required to further evaluate the indications and role of early laparoscopic washout post-appendicectomy.
References
- 1AsariasJR, SchlusselAT, CafassoDE, CarlsonTL, KasprenskiMC, WashingtonEN et al. Incidence of postoperative intraabdominal abscesses in open versus laparoscopic appendectomies. Surg Endosc (2011) 25(8): 2678–26832141617510.1007/s00464-011-1628-y
- 2NatarajaRM, LoukogeorgakisSP, SherwoodWJ, ClarkeSA, HaddadMJ The incidence of intraabdominal abscess formation following laparoscopic appendicectomy in children: a systematic review and meta-analysis. J Laparoendosc Adv Surg Tech A (2013) 23(9): 795–8022400115910.1089/lap.2012.0522
- 3KatkhoudaN, FriedlanderMH, GrantSW, AchantaKK, EssaniR, PaikP et al. Intraabdominal abscess rate after laparoscopic appendectomy. Am J Surg (2000) 180(6): 456–4591118239710.1016/S0002-9610(00)00504-3(discussion 460–1)
- 4AllawayMGR, EslickGD, KwokGTY, CoxMR The established acute surgical unit: a reduction in nighttime appendicectomy without increased morbidity. Int J Surg (2017) 24(43): 81–8510.1016/j.ijsu.2017.05.045
10.1016/j.ijsu.2017.05.045 Google Scholar
- 5Allaway MGR, Clement K, Eslick GD, Cox MR. The unacceptable morbidity of negative laparoscopic appendicectomy. World J Surg (in Press)
- 6van WijckK, de JongJR, van HeurnLWE, van der ZeeDC Prolonged antibiotic treatment does not prevent intra-abdominal abscesses in perforated appendicitis. World J Surg (2010) 34(12): 3049–30532080915110.1007/s00268-010-0767-y
- 7KrisherSL, BrowneA, DibbinsA, TkaczN, CurciM Intra-abdominal abscess after laparoscopic appendectomy for perforated appendicitis. Arch Surg (2001) 136(4): 438–4411129611610.1001/archsurg.136.4.438
- 8AzzarelloG, LanteriR, RapisardaC, SantangeloM, RacalbutoA, MinutoloV et al. Ultrasound-guided percutaneous treatment of abdominal collections. Chir Ital (2009) 61(3): 337–34019694236
- 9GervaisDA, BrownSD, ConnollySA, BrecSL, HarisinghaniMG, MuellerPR Percutaneous imaging-guided abdominal and pelvic abscess drainage in children. Radiographics (2004) 24(3): 737–7541514322510.1148/rg.243035107
- 10OkoyeBO, RampersadB, MarantosA, AbernethyLJ, LostyPD, LloydDA Abscess after appendicectomy in children: the role of conservative management. Br J Surg (1998) 85(8): 1111–1113971800810.1046/j.1365-2168.1998.00782.x
- 11ForguesD, HabbigS, DialloAF, KalfaN, LopezM, AllalH et al. Post-appendectomy intra-abdominal abscessesߝcan they successfully be managed with the sole use of antibiotic therapy?. Eur J Pediatr Surg (2007) 17(2): 104–1091750330310.1055/s-2007-965015
- 12BenoistS, PanisY, PannegeonV, SoyerP, WatrinT, BoudiafM et al. Can failure of percutaneous drainage of postoperative abdominal abscesses be predicted?. Am J Surg (2002) 184(2): 148–1531216935910.1016/S0002-9610(02)00912-1
- 13KumarRR, KimJT, HaukoosJS, MaciasLH, DixonMR, StamosMJ et al. Factors affecting the successful management of intra-abdominal abscesses with antibiotics and the need for percutaneous drainage. Dis Colon Rectum (2006) 49(2): 183–1891632296010.1007/s10350-005-0274-7
- 14HélouryY, BaronM, BourgoinS, WetzelO, LejusC, PlattnerV Medical treatment of postappendectomy intraperitoneal abscesses in children. Eur J Pediatr Surg (1995) 5(3): 149–151754780010.1055/s-2008-1066191
- 15DobremezE, LavrandF, LefevreY, BoerM, BondonnyJ-M, VergnesP Treatment of post-appendectomy intra-abdominal deep abscesses. Eur J Pediatr Surg (2003) 13(6): 393–3971474332710.1055/s-2003-44729
- 16GorterRR, MeiringS, van der LeeJH, HeijHA Intervention not always necessary in post-appendectomy abscesses in children; clinical experience in a tertiary surgical centre and an overview of the literature. Eur J Pediatr (2016) 175(9): 1185–11912751104610.1007/s00431-016-2756-0
- 17BrolinRE, NosherJL, LeimanS, LeeWS, GrecoRS Percutaneous catheter versus open surgical drainage in the treatment of abdominal abscesses. Am Surg (1984) 50(2): 102–1086703514
- 18MulierS, PenninckxF, VerwaestC, FilezL, AertsR, FieuwsS et al. Factors affecting mortality in generalized postoperative peritonitis: multivariate analysis in 96 patients. World J Surg (2003) 27(4): 379–3841265847710.1007/s00268-002-6705-x
- 19LammeB, BoermeesterMA, BeltEJT, van TillJWO, GoumaDJ, ObertopH Mortality and morbidity of planned relaparotomyversus relaparotomy on demand for secondary peritonitis. Br J Surg (2004) 91(8): 1046–10541528696910.1002/bjs.4517
- 20van RulerO, MahlerCW, BoerKR, ReulandEA, GooszenHG, OpmeerBC et al. Comparison of on-demand vs planned relaparotomy strategy in patients with severe peritonitis. JAMA (2007) 298(8): 8651771207010.1001/jama.298.8.865
- 21MandellK, ArbabiS Re-laparotomy for severe intra-abdominal infections. Surg Infect (Larchmt) (2010) 11(3): 307–31010.1089/sur.2010.023
- 22AbularrageCJ, BloomS, BrunoDA, GoldfarbA, AbularrageJJ, ChahineAA Laparoscopic drainage of postappendectomy-retained fecalith and intra-abdominal abscess in the pediatric population. J Laparoendosc Adv Surg Tech A (2008) 18(4): 644–6501872102410.1089/lap.2007.0190
- 23AzizDAA, SaidS, OsmanM, LimF, Mohd NorM, Mohd ZakiF et al. The role of delayed laparoscopic suction for intra-abdominal collection or abscess post appendectomy in paediatric patients: case series and review of literature. Mini Invasive Surg (2017) Jan: 22
- 24ClarkJJ, JohnsonSM Laparoscopic drainage of intraabdominal abscess after appendectomy: an alternative to laparotomy in cases not amenable to percutaneous drainage. J Pediatr Surg (2011) 46(7): 1385–13892176383910.1016/j.jpedsurg.2011.01.003
- 25KokKY, YappSK Laparoscopic drainage of postoperative complicated intra-abdominal abscesses. Surg Laparosc Endosc Percutaneous Tech (2000) 10(5): 311–31310.1097/00019509-200010000-00010
- 26OwensWD, FeltsJA, SpitznagelEL ASA physical status classifications: a study of consistency of ratings. Anesthesiology (1978) 49(4): 239–24369707710.1097/00000542-197810000-00003
- 27BoneRC, BalkRA, CerraFB, DellingerRP, FeinAM, KnausWA et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM consensus conference committee. American college of chest physicians/society of critical care medicine. Chest (1992) 101(6): 1644–1655130362210.1378/chest.101.6.1644
- 28DindoD, DemartinesN, ClavienP-A Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg (2004) 240(2): 205–2131527354210.1097/01.sla.0000133083.54934.ae
- 29PaikPS, TowsonJA, AnthoneGJ, OrtegaAE, SimonsAJ, BeartRW Intra-abdominal abscesses following laparoscopic and open appendectomies. J Gastrointest Surg (1997) 1(2): pp. 188–92–discussion192–310.1016/S1091-255X(97)80108-4
10.1016/S1091-255X(97)80108-4 Google Scholar
- 30SauerlandS, JaschinskiT, NeugebauerEA Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev (2010) 6;23(10): CD001546
- 31DaiL, ShuaiJ Laparoscopic versus open appendectomy in adults and children: a meta-analysis of randomized controlled trials. United Eur Gastroenterol J (2017) 5(4): 542–55310.1177/2050640616661931
- 32QuahGS, EslickGD, CoxMR Laparoscopic vs. open surgery for complicated appendicitis: a meta-analysis. Aust N Z J Surg (2018) 88(S1): 55–56
- 33MazuskiJE, TessierJM, MayAK, SawyerRG, NadlerEP, RosengartMR et al. The surgical infection society revised guidelines on the management of intra-abdominal infection. Surg Infect (Larchmt) (2017) 18(1): 1–7610.1089/sur.2016.261
- 34GorensteinA, GewurtzG, SerourF, SomekhE Postappendectomy intra-abdominal abscess: a therapeutic approach. Arch Dis Child (1994) 70(5): 400–402801796110.1136/adc.70.5.400
- 35PiperHG, DerinkuyuB, KoralK, PerezEA, MurphyJT Is it necessary to drain all postoperative fluid collections after appendectomy for perforated appendicitis?. J Pediatr Surg (2011) 46(6): 1126–11302168321010.1016/j.jpedsurg.2011.03.043
- 36BuckleyBT, GoodwinM, BoardmanP, UberoiR Percutaneous abscess drainage in the UK: a national survey and single centre study. Clin Radiol (2006) 61(1): pp. 55–64–discussion53–410.1016/j.crad.2005.08.014
10.1016/j.crad.2005.08.014 Google Scholar
- 37Jarvi K, Roebuck DJ, Drake DP, Curry JI. Image-guided drainage of post-appendectomy intra-abdominal abscess in children: a 6-year review. J Paediatr Surg Spec. http://www.jpss.eu/index.php/current-issue/item/285-image-guided-drainage-of-post-appendectomy-intra-abdominal-abscess-in-children-a-6-year-review. Accessed 12 Feb 2018
- 38JohnsonWC, GerzofSG, RobbinsAH, NabsethDC Treatment of abdominal abscesses: comparative evaluation of operative drainage versus percutaneous catheter drainage guided by computed tomography or ultrasound. Ann Surg (1981) 194(4): 510–520728351010.1097/00000658-198110000-00014
- 39MalangoniMA, ShumateCR, ThomasHA, RichardsonJD Factors influencing the treatment of intra-abdominal abscesses. Am J Surg (1990) 159(1): 167–171229479510.1016/S0002-9610(05)80623-3
- 40KopernaT, SchulzF Relaparotomy in peritonitis: prognosis and treatment of patients with persisting intraabdominal infection. World J Surg (2000) 24(1): 32–371059420010.1007/s002689910007
- 41AllawayMGR, EslickGD, CoxMR The unacceptable morbidity of negative laparoscopic appendicectomy. World J Surg (2018) 14(2): 23710.1007/s00268-018-4784-6
10.1007/s00268?018?4784?6 Google Scholar
- 42TiwariMM, ReynosoJF, TsangAW, OleynikovD Comparison of outcomes of laparoscopic and open appendectomy in management of uncomplicated and complicated appendicitis. Ann Surg (2011) 254(6): 927–9322180438110.1097/SLA.0b013e31822aa8ea
- 43BuschM, GutzwillerFS, AelligS, KuettelR, MetzgerU, ZinggU In-hospital delay increases the risk of perforation in adults with appendicitis. World J Surg (2011) 35(7): 1626–16332156287110.1007/s00268-011-1101-z
