Prospective validation of a therapeutic algorithm for postoperative intra-abdominal abscess after laparoscopic appendectomy

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Antibiotics; Intra-abdominal abscess; Laparoscopic appendectomy; Laparoscopy; Percutaneous drainage.