Antimicrobial treatment after laparoscopic appendectomy for preventing a post-operative intraabdominal abscess: A Prospective Cohort Study of 1817 patients

• The complete infectious source control is more important than antibiotics treatment for preventing a post-appendectomy intraabdominal abscess.
• Prolonged antibiotic treatment cannot prevent post-operative intraabdominal abscess after laparoscopic appendectomy.
• When the infectious source control is incomplete, we recommend a 5-day course of antimicrobial combination therapy and consecutive source control such as peritoneal drainage.

IntroductionPost-operative antimicrobial treatment is usually administered to prevent a post-operative intraabdominal abscess (IAA) after laparoscopic appendectomy (LA). The aim of this study was to identify the role of post-operative antibiotic treatment and the optimal length for the antibiotic course to prevent post-operative IAA after LA.MethodsBetween January 2010 and December 2013, 1817 patients who underwent three-port LA were enrolled in this study. Patients were classified into four groups according to the type of appendicitis and infectious source control. The characteristics of antimicrobial treatment and the incidence of IAA were analyzed and compared among the four groups.ResultsThe incidence of IAA after three-port LA was 1.5% (27/1817). The mean durations of post-operative antibiotic use were 3.1 days for the non-IAA group and 3.3 days for the IAA group, with no significant difference between the groups (p = 0.510).DiscussionThe length of post-operative antibiotic treatment and antimicrobial combination therapy did not affect the development of IAA, and prolonged antibiotic treatment did not prevent IAA. However, when source control was not completely achieved, an IAA was frequently observed in the patient group that received a short course of antibiotic treatment.ConclusionThe role of antibiotic treatment for preventing post-appendectomy IAA seems to be related with achieving intraperitoneal infectious source control. In the setting of incomplete source control, we recommend a 5-day course of antimicrobial combination therapy and consecutive source control such as peritoneal drainage.