Identification of risk factors for post-operative intra-abdominal abscess following laparoscopic appendectomy for acute appendicitis. An observational, prospective and comparative study

INTRODUCTION. Intra-abdominal abscesses (IAA) develop in up to 5% of patients after laparoscopic appendectomies for acute appendicitis. There is no consensus about their etiology in the literature. Some authors speculate that they might be influenced by the type of closure technique and the occurrence of an appendicular perforation. The aim of this study was to identify preoperative, intraoperative and postoperative risk factors for IAA in patients undergone laparoscopic appendectomy for acute appendicitis. METHODS. The charts of 2076 consecutive patients, operated between 2001 and 2013 receiving laparoscopic appendectomy for acute appendicitis, were analyzed. The risk of postoperative intra-abdominal abscesses was investigated for different demographics, clinical and intraoperative variables, using univariate and multivariate analyses. RESULTS. 37 patients (1.8%) presented a postoperative IAA. Based on the multivariate analysis, the presence of a localized peritonitis (OR 2.982; 95 % CI 1.41-6.27; p = 0.004), a perforated appendicitis (OR 2.397; 95 % CI 1.04-5.51; p = 0.04), the intraoperative coagulation of the mesoappendix (OR 6.722; 95 % CI 3.03-14.87; p < 0.0001), the duration of the operation (OR 1.011; 95 % CI 1.00-1.02; p = 0.013) and the post-operative hospital stay (OR 1.309; 95 % CI 1.19-1.30; p < 0.0001) were identified as independent predictive factors for the development of postoperative intra-abdominal abscesses. The Hosmer-Lemeshow test was not statistically significant, showing an acceptable level of goodness of fit (p = 0.470). CONCLUSION. Patients with a localized peritonitis, a perforated appendicitis, an intraoperative coagulation of the mesoappendix, a surgical time longer than 90 minutes and a longer post-operative stay have higher chance of having a postoperative IAA. A close post-operative follow up should be necessary in these situations in order to prevent and identify IAA after a laparoscopic appendectomy.