Early Laparoscopic Washout may Resolve Persistent Intra‐abdominal Infection Post‐appendicectomy

Abstract

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.

Non‐operative management of small post‐appendicectomy intra‐abdominal abscess is safe and effective

“…8 As IAA is more commonly associated with complicated appendicitis compared with uncomplicated appendicitis [4][5][6] but has a similar incidence for uncomplicated appendicitis and a normal appendix, 8 this is less likely to be the sole explanation. Another explanation is the use of laparoscopic washout in 41 (0.8%) patients with persistent evidence of sepsis following appendicectomy during the study period 37 that may have resulted in the prevention of the subsequent development of an IAA. However, the retrospective nature of this case series makes that difficult to confirm.…”

Relaparotomy and repeated minimally invasive interventions in hepatobiliary surgery

“…Неудивительно, что значительное увеличение количества оперативных вмешательств на печени и желчевыводящих путях способство вало увеличению частоты ранних послеопераци онных внутрибрюшных осложнений (РПВО), тре бующих выполнения релапаротомии. По данным литературы последних лет частота релапаротомии находится в пределах 0,5-8,6% [1-3, 5], при этом летальность варьирует от 18,8 до 48% [4,5], а при повторных релапаротомиях и послеоперационном перитоните достигает 90% [6][7][8].…”

Choice of tactics for surgical correction of postoperative intra-abdominal bleeding during surgery in the hepatobiliary zone

“…Частота развития этого осложнения в гепатобилиарной хирургии достигает от 1,4 до 29,0% [4][5][6][7]. Летальность при послеоперационных внутрибрюшных кровотечениях (ПВК) и кровотечениях в просвет пищеварительного тракта (КППТ) составляет от 22 до 54% [8][9][10][11]. Особое значение этой проблеме придает то обстоятельство, что основные причины ПВК обусловлены техническими и тактическими ошибками в процессе выполнения операции, тогда как возникновению КППТ способствует травматичность операции, ишемические и стрессовые повреждения, а также явления транзиторной портальной гипертензии [12,13].…”