Usefulness of intraoperative culture swabs in laparoscopic appendectomy for complicated appendicitis

• Published in: Langenbeck's archives of surgery Vol. 405; no. 5; pp. 691 - 695
• Main Authors: Peña, María E., Sadava, Emmanuel E., Laxague, Francisco, Schlottmann, Francisco
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-08-2020
• Subjects: Abdominal Surgery; Cardiac Surgery; General Surgery; Medicine; Medicine & Public Health; Original Article; Thoracic Surgery; Traumatic Surgery; Vascular Surgery; Laparoscopic appendectomy; Complicated appendicitis; Culture swabs; Intraabdominal abscess
• ISSN: 1435-2443; 1435-2451
• DOI: 10.1007/s00423-020-01913-z

Purpose
Intraabdominal abscess (IAA) is a feared complication after laparoscopic appendectomy (LA) for complicated appendicitis. Benefits of obtaining intraoperative culture swabs (ICS) still remain controversial. We aimed to determine whether ICS modify the rate and management of IAA after LA for complicated appendicitis.
Methods
A consecutive series of patients who underwent LA for complicated appendicitis from 2008 to 2018 were included. The cohort was divided into two groups: group 1 (G1), with ICS, and group 2 (G2), without ICS. Demographics, operative variables, pathogen isolation, antibiotic sensitivity, and postoperative outcomes were analyzed.
Results
A total of 1639 LA were performed in the study period. Of these, 270 (16.5%) were complicated appendicitis; 90 (33%) belonged to G1 and 180 (67%) to G2. In G1, a higher proportion of patients had generalized peritonitis (G1, 63.3%; G2, 35%;
p
 < 0.01). Seventy-two (80%) patients had positive cultures in G1. The most frequently isolated bacteria were
E. coli
(66.7%),
Bacteroides
spp. (34.7%), and
Streptococcus
spp. (19.4%). In 26 (36%) patients, the initial empiric antibiotic course was modified due to bacterial resistance. The rate of IAA was higher in patients with ICS (G1, 21.1%; G2, 9.4%;
p
 = 0.01). IAA was treated similarly in both groups. A different type of bacteria was isolated in 7 (53.8%) patients with new culture swabs.
Conclusions
Obtaining ICS in LA for complicated appendicitis with further antibiotic adjustment to the initial pathogen did not lower the incidence of postoperative IAA and did not modify the treatment needed for this complication.