Infectious complications following laparoscopic appendectomy.

Introduction: A meta-analysis of the literature suggests there is an increased rate of intra-abdominal abscess after laparoscopic appendectomy (LA) compared with open appendectomy (OA).

Methods: To analyze the infectious complications of LA at one tertiary care centre, we completed a retrospective chart review for all patients undergoing LA for acute appendicitis from 1995 to 2002.

Results: We used established exclusion criteria to identify 175 patients with a mean age of 37.6 (standard deviation [SD] 14.5) years (95 male, 80 female). The mean operating time was 61.9 (SD 22.5) minutes. Excluding conversions to OA (14/175, 8%), operating time was 59.9 (SD 20.5) minutes. On surgical assessment, 143 patients had acute nonperforated appendicitis (17 perforated, 15 gangrenous). However, on histopathology assessment, 13 cases of normal appendix were identified (13/175, 7.4%). The overall median length of stay was 2.0 days. Three patients had significant postoperative infectious complications, including 1 wound infection and 2 cases of intra-abdominal abscesses. All abscesses were managed successfully with percutaneous drainage. An analysis of perioperative factors that might have contributed to the infectious complications revealed that each case of postoperative intra-abdominal abscess occurred in patients with gangrenous appendicitis and when extensive irrigation was used during LA.

Conclusions: An institutional review demonstrates outcomes comparable with the Cochrane systematic review of the published literature. Technical issues that may impact on intra-abdominal abscess formation after LA include aggressive manipulation of the infected appendix and increased use of irrigation fluid, possibly producing greater contamination of the peritoneal cavity.