Risk Factors Affecting Postoperative Morbidity in Laparoscopic Treatment of Perforated Appendicitis, a Single- Center Experience

Objective: Postoperative morbidity may occur more in laparoscopic treatment of perforated appendicitis than simple appendicitis. In this study,we aimed to investigate the risk factors affecting the development of morbidity in laparoscopic treatment of perforated appendicitis.Method: The files of patients who underwent laparoscopic appendectomy due to perforated appendicitis were analysed retrospectively. Findingof perforation has been documented by surgeons who performed surgery. Information on the patients such as age, gender, Charlson ComorbidityIndex (CCI), body mass index (BMI), ASA scores, symptom onset time, time between hospital admission and surgery, surgical findings, perforationsites, type of surgery, stump closure materials, white blood cell counts, pathology results and postoperative morbidities were recorded. Data werecompared between patients with and without morbidity, and multivariate regression analysis of variables with significant p value wasperformed.Results: The rate of morbidity development in laparoscopic treatment of perforated appendicitis was 22.14% (66/298). In multivariate regressionanalysis, the onset of symptoms longer than 72 hours, proximal perforation, grade 5 diffuse peritonitis in surgical finding according to DiseaseSeverity Score (DSS), conversion from laparoscopic to open surgery and gangrene or necrosis in histopathological finding were found to beeffective risk factors in the development of morbidity. (p=0.013, odds ratio=1,455, p=0.010, odds ratio=2.009, p=0.002, odds ratio=2.648, p=0.014, odds ratio=6.537, p=0.003, odds ratio=1.843; respectively).Conclusion: The development of postoperative morbidity in laparoscopic treatment of perforated appendicitis is associated with late admissiondevelopment of diffuse peritonitis, conversion to open surgery, proximal perforation and presence of necrosis. According to odds ratio, the riskfactor with the highest probability of developing morbidity was found to be conversion to open surgery. We think that patients diagnosed withperforated appendicitis should be operated on as early as possible, routinely placing a drain should be avoided, and laparoscopic approachshould be preferred as much as possible to reduce the morbidity rates.

Perfore Apandisitlerin Laparoskopik Tedavisinde Morbidite Gelişimi Üzerine Etkili Risk Faktörleri, Tek Merkez Deneyimi

Amaç: Perfore apandisitlerin laparoskopik tedavisinde postoperatif morbidite basit apandisitlere göre daha fazla gelişmektedir. Biz bu çalışmada, perfore apandisitlerin laparoskopik tedavisinde morbidite gelişimine etki eden risk faktörlerini araştırmayı amaçladık. Yöntem: Perfore apandisit nedeniyle laparoskopik apendektomi yapılan hastaların dosyaları retrospektif olarak incelendi. Perforasyon bulgusu ameliyatı yapan cerrahlar tarafından belgelenmiştir. Çalışmaya dahil edilen hastaların yaşı, cinsiyeti, Charlson Komorbidite Indeksi (CCI), vücut kitle indeksi (VKİ) ASA skorları, semptom başlangıç ve hastane başvuru ile ameliyat arasında geçen süreleri, ameliyat bulguları, perforasyon yerleri, ameliyat şekilleri, güdük kapatma materyalleri, lökosit değerleri, patoloji sonuçları ve postoperatif morbiditeleri kayıt altına alındı. Veriler morbidite gelişen ve gelişmeyen hastalarda karşılaştırıldı ve p değeri anlamlı çıkan değişkenlerin multivariate regresyon analizi yapıldı. Bulgular: Perfore apandisitlerin laparoskopik tedavisinde mobidite gelişme oranı %22.14 (66/298) olarak izlenmiştir. Multivariate regresyon analizinde semptom başlangıcının üzerinden 72 saat geçmesi, ameliyat bulgularına göre perforasyon yerinin radiks olması, DSS’ye göre ameliyat bulgusunda grade 5 diffuz peritonit tablosu olması, laparoskopiden açığa dönülmesi ve post operatif histopatolojik bulguda gangren veya nekroz olması post operatif morbidite gelişimi üzerine etkili risk faktörleri olarak bulunmuştur (p=0.013, olasılık oranı=1,455; p=0.010, olasılık oranı=2.009; p=0.002, olasılık oranı=2.648; p=0.014, olasılık oranı=6.537; p=0.003, olasılık oranı=1.843; sırasıyla). Sonuç: Perfore apandisitlerin laparoskopik tedavisinde post operatif morbidite gelişimi geç başvuru, diffüz peritonit gelişimi, açığa dönüş, radiks perforasyonu ve nekroz varlığı ile ilişkilidir. Olasılık oranlarına göre morbidite gelişme ihtimali en yüksek olan risk faktörü açığa dönüş olarak bulunmuştur. Apandisit perforasyonu tanısı alan hastaların olabildiğince erken ameliyat edilmesi, rutin dren yerleştirilmemesi ve morbidite gelişimini önlemek için mümkün olduğunca laparoskopik yaklaşım uygulanması gerektiğini düşünüyoruz.

Kaynakça

1. Sauerland S, Lefering R, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev. 2002;(1):CD001546. https://doi.org/10.1002/14651858.CD001546

2. Cao J, Tao F, Xing H, et al. Laparoscopic Procedure is Not Independently Associated With the Development of Intra Abdominal Abscess After Appendectomy. Surg Laparosc Endosc Percutan Tech. 2017;27(5):409-14. https://doi.org/10.1097/SLE.0000000000000460

3. Al-Omran M, Mamdani M, McLeod RS. Epidemiologic features of acute appendicitis in Ontario, Canada. Can J Surg. 2003;46(4):263-8. Available from: https://www.ncbi.nlm.nih. gov/pmc/articles/PMC3211626/

4. Fike FB, Mortellaro VE, Juang D, et al. The impact of postoperative abscess formation in perforated appendicitis. J Surg Res. 2011;170(1):24-6. https://doi.org/10.1016/j.jss.2011.03.038

5. Barrett ML, Hines AL, Andrews RM. Trends in Rates of Perforated Appendix, 2001-2010. Available from: https:// www.hcup-us.ahrq.gov/reports/statbriefs/sb159.pdf (cited 2018 April 1).

6. Andersson RE. Short and long-term mortality after appendectomy in Sweden 1987 to 2006. Influence of appendectomy diagnosis, sex, age, co-morbidity, surgical method, hospital volume, and time period. A national population-based cohort study. World J Surg. 2013;37(5):974-81. https://doi.org/10.1007/s00268-012-1856-x

7. Golub R, Siddiqui F, Pohl D. Laparoscopic versus open appendectomy: a meta-analysis. J Am Coll Surg. 1998;186(5):545- 53. https://doi.org/10.1016/S1072-7515(98)00080-5

8. Andersson RE. Short-term complications and longterm morbidity of laparoscopic and open appendicectomy in a national cohort. Br J Surg. 2014;101(9):1135-42. https://doi.org/10.1002/bjs.9552

9. Frazee RC, Roberts JW, Symmonds RE, et al. A prospective randomized trial comparing open versus laparoscopic appendectomy. Ann Surg. 1994;219(6):725-8; discussion 728-31. https://doi.org/10.1097/00000658-199406000-00017

10. Guller U, Hervey S, Purves H, et al. Laparoscopic versus open appendectomy: outcomes comparison based on a large administrative database. Ann Surg. 2004;239(1):43-52. https://doi.org/10.1097/01.sla.0000103071.35986.c1

11. Sauerland S, Jaschinski T, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev. 2010;(10):CD001546. https://doi.org/10.1002/14651858.CD001546.pub3

12. Gorter RR, Eker HH, Gorter-Stam MA, et al. Diagnosis and management of acute appendicitis. EAES consensus development conference 2015. Surg Endosc. 2016;30(11):4668-90. https://doi.org/10.1007/s00464-016-5245-7

13. Ming PC, Yan TY, Tat LH. Risk factors of postoperative infections in adults with complicated appendicitis. Surg Laparosc Endosc Percutan Tech. 2009;19(3):244-8. https://doi.org/10.1097/SLE.0b013e3181a4cda2

14. Luo CC, Chien WK, Huang CS, et al. National trends in therapeutic approaches and outcomes for pediatric appendicitis: aTaiwanese nationwide cohort study. Pediatr Surg Int. 2015;31(7):647-51. https://doi.org/10.1007/s00383-015-3718-8

15. Garst GC, Moore EE, Banerjee MN, et al. Acute appendicitis: a disease severity score for the acute care surgeon. J Trauma Acute Care Surg. 2013;74(1):32-6. https://doi.org/10.1097/TA.0b013e318278934a

16. Humes DJ, Simpson J. Acute appendicitis. BMJ. 2006; 333(7567):530-4. https://doi.org/10.1136/bmj.38940.664363.AE

17. Lasek A, Pędziwiatr M, Wysocki M, et al. Risk factors for intraabdominal abscess formation after laparoscopic appendectomy-results from the Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study. Wideochir Inne Tech Maloinwazyjne. 2019;14(1):70-8. https://doi.org/10.5114/wiitm.2018.77272

18. Tartaglia D, Fatucchi LM, Mazzoni A, et al. Risk factors for intra-abdominal abscess following laparoscopic appendectomy for acute appendicitis: a retrospective cohort study on 2076 patients. Updates Surg. 2020 Apr 27. https://doi.org/10.1007/s13304-020-00749-y

19. Frazee R, Abernathy S, Davis M, et al. Fast track pathway for perforated appendicitis. Am J Surg. 2017;213(4):739-41. https://doi.org/10.1016/j.amjsurg.2016.08.006

20. Beek MA, Jansen TS, Raats JW, et al. The utility of peritoneal drains in patients with perforated appendicitis. Springerplus. 2015;4:371. https://doi.org/10.1186/s40064-015-1154-9

21. Guy S, Wysocki P. Risk factors for intra-abdominal abscess post laparoscopic appendicectomy for gangrenous or perforated appendicitis: A retrospective cohort study. International Journal of Surgery Open. 2018;10:47-54. https://doi.org/10.1016/j.ijso.2017.12.003

22. Asarias JR, Schlussel AT, Cafasso DE, et al. Incidence of postoperative intraabdominal abscesses in open versus laparoscopic appendectomies. Surg Endosc. 2011;25(8):2678-83. https://doi.org/10.1007/s00464-011-1628-y

23. Ming PC, Yee Yan TY, Tat LH. Risk factors of postoperative infections in adults with complicated appendicitis. Surg Laparosc Endosc Percutan Tech. 2009;19(3):244-8. https://doi.org/10.1097/SLE.0b013e3181a4cda2

24. Cho J, Park I, Lee D, Sung K, Baek J, Lee J. Risk factors for postoperative intra-abdominal abscess after laparoscopic appendectomy: analysis for consecutive 1,817 experiences. Dig Surg. 2015;32(5):375-81. https://doi.org/10.1159/000438707

25. Fair BA, Kubasiak JC, Janssen I, et al. The impact of operative timing on outcomes of appendicitis: a National Surgical Quality Improvement Project analysis. Am J Surg. 2015;209(3):498-502. https://doi.org/10.1016/j.amjsurg.2014.10.013

26. van Dijk ST, van Dijk AH, Dijkgraaf MG, Boermeester MA. Meta-analysis of in-hospital delay before surgery as a risk factor for complications in patients with acute appendicitis. Br J Surg. 2018;105(8):933-45. https://doi.org/10.1002/bjs.10873

27. Andert A, Alizai HP, Klink CD, et al. Risk factors for morbidity after appendectomy. Langenbecks Arch Surg. 2017;402(6):987- 93. https://doi.org/10.1007/s00423-017-1608-3

28. Swank HA, van Rossem CC, van Geloven AAW, et al. Endostapler or endoloops for securing the appendiceal stump in laparoscopic appendectomy: a retrospective cohort study. Surg Endosc. 2014;28(2):576-83. https://doi.org/10.1007/s00464-013-3207-x

29. Al-Temimi MH, Berglin MA, Kim EG, et al. Endostapler versus Hem-O-Lok clip to secure the appendiceal stump and mesoappendix during laparoscopic appendectomy. Am J Surg. 2017;214(6):1143-8. https://doi.org/10.1016/j.amjsurg.2017.08.031

30. Mannu GS, Sudul MK, Bettencourt-Silva JH, et al. Closure methods of the appendix stump for complications during laparoscopic appendectomy. Cochrane Database Syst Rev. 2017;11(11):CD006437. https://doi.org/10.1002/14651858.CD006437.pub3

31. Ceresoli M, Tamini N, Gianotti L, et al. Are endoscopic loop ties safe even in complicated acute appendicitis? A systematic review and meta-analysis. Int J Surg. 2019;68:40-7. https://doi.org/10.1016/j.ijsu.2019.06.011

32. Aneiros Castro B, Cano I, García A, et al. Abdominal drainage after laparoscopic appendectomy in children: an endless controversy? Scand J Surg. 2018;107(3):197-200. https://doi.org/10.1177/1457496918766696

33. Li Z, Zhao L, Cheng Y, et al. Abdominal drainage to prevent intra-peritoneal abscess after open appendectomy for complicated appendicitis. Cochrane Database Syst Rev. 2018;5(5):CD010168. https://doi.org/10.1002/14651858.CD010168.pub3

Kaynak Göster

Bakırköy Tıp Dergisi
  • ISSN: 1305-9319
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 2005
  • Yayıncı: Hira Gizem Fidan

21.1b22.7b

Sayıdaki Diğer Makaleler

Epidemiology and the Risk Factors for Mortality in Ventilator-Associated Pneumonia

Zuhal YEŞİLBAĞ, Yasemin TEKDÖŞ ŞEKER

Assessment of Knowledge Levels of Nurses Working in Surgical Clinics About ERAS Protocol

Pınar ONGÜN, Ezgi SEYHAN AK

The Clinicopathologic Features and the Factors Associated with the Survival in Light -Chain Amyloidosis Patients: A Single Center Descriptive Study

Pelin AYTAN, Mahmut YERAL, Çiğdem GEREKLİOĞLU, Mutlu KASAR, Aslı KORUR, Nurhilal BÜYÜKKURT, Süheyl ASMA, Ilknur KOZANOĞLU, Hakan ÖZDOĞU, Can BOĞA

Our Surgical Experience in Anomalous Opening of the Common Bile Duct

Ahmet SARITAŞ, Abdullah ÜLKÜ, Uğur TOPAL, Kubilay DALCI, Burak YAVUZ, Oğuz ÜSKÜDAR, Atılgan Tolga AKÇAM

Effectiveness of Sonoelastography and Diffusion MRI ADC Value In Discriminating Between Malignant and Benign Lesions of the Breast

Sultan MAÇİN, Muhammed Akif DENIZ, Yaşar BÜKTE, Zelal Taş DENIZ, Özgür SARICA, Aslıhan SEMİZ OYSU

Evaluation of Systemic Steroid Response Via Digital Infrared Thermal Imaging (DITI) in Patients with Idiopathic Granulomatous Mastitis

Murat ŞENDUR, Engin HATİPOĞLU, Varol ÇELİK

Association of Myeloperoxidase Gene Functional Variant with Schizophrenia and Smoking in a Turkish Population

Sacide PEHLİVAN, Pınar ÇETİNAY, M. Atilla UYSAL, Ayşe Feyda NURSAL, Selin KURNAZ, Ulgen SEVER, Aybike AYDIN, Nazan AYDIN, Mustafa PEHLİVAN

Is the Use of a Stapler for Ileocolic Anastomosis Linked to Anastomotic Leakage?

Tolga ÖLMEZ, Orhan UZUN, Ömer ÖZDUMAN, Selçuk GÜLMEZ, Ayhan ÖZ, Erdal POLAT, Mustafa DUMAN

Risk Factors Affecting Postoperative Morbidity in Laparoscopic Treatment of Perforated Appendicitis, a Single- Center Experience

Ahmet SÜREK, Mehmet KARABULUT

Dosimetric Comparison of Volumetric Modulated Arc Therapy (VMAT) and Helical Tomotherapy for Hippocampal-Avoidance Prophylactic Whole Brain Radiotherapy (HA-PWBRT) in Small Cell Lung Cancer; Treatment Plans Based Study

Ozlem Yetmen DOGAN, Nilsu CİNİ, Sevecen Seyhun Nasır CAN