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THE NEGATIVE EFFECT OF THE LARGE AMOUNT OF PERITONEAL LAVAGE ON POST-OPERATIVE INTRA-ABDOMINAL ABSCESS FORMATION
Miyako Tanaka*, Fukashi Serizawa, Takuya Jimbo, Kazuki Kawashima, Takeshi Asakura, Hiroshi Otomo, Kenichi Yokota
Surgery, Kesennuma City Hospital, Kesennuma, Japan
Background: Post-operative intra-abdominal abscess is one of the most critical complication after appendectomy, and effective managements to prevent intra-abdominal abscess is still controversial. We hypothesized the incidence of intra-abdominal abscess formation depended on the peritoneal lavage volume during surgery.
Objectives: We enrolled 96 patients (63 males and 33 females) who were underwent appendectomies for gangrenous and perforated appendicitis from January 2007 to August 2016 at Kesennnuma city hospital. Patient`s age was 51.2 ± 2.0. Under the age of 18 and cancer related appendicitis cases were excluded. Patients were divided into 2 groups according to their development of post-operative intra-abdominal abscess (intra-abdominal abscess group (IAA group, n = 17) and non-intra-abdominal abscess group (non-IIA group, n = 79). Patient’s background characteristics including age, sex, BMI, past history, stercolith, ascites, time to surgery from symptoms onset, pre-operative intra-abdominal abscess formation, anti-biotics agents, peritoneal lavage volume, white blood cell count (WBC), C-Reactive protein (CRP), pathological findings were compared between these two groups. The peritoneal lavage volume was corrected with body surface area.
Results: The risk factors associated with post-operative intra-abdominal abscess formation were older age (p = 0.02), pre-operative intra-abdominal abscess formation (p < 0.01), high CRP values (p < 0.01) and lower serum albumin levels (p < 0.01). No significant difference was observed in the time from symptoms onset to surgery between IAA (66 ± 7 hours) and non-IAA (98 ± 27 hours) groups (p = 0.31, N.S.). The peritoneal lavage volume was larger in IAA group even though we corrected with body surface area (p < 0.01). Decreasing rates of WBC and CRP on 1 to 3 post-operative day were lower in IAA group (p < 0.01, each).
Conclusions: Surgeons usually carry out the peritoneal lavage with large quantities of water if peritoneal severe pollution was found. However, simple lavage was not effective to prevent post-operative intra-abdominal abscess formation. Our findings may indicate a negative effect of a large amount of peritoneal lavage.
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