M. Khan1, M. H. Siddiqui1, N. Shahzad1, M. B. Chaudhry2, M. Wajid1, R. Sultan1, W. A. Memon2, H. Zafar1, A. Alvi1 1Aga Khan University Medical College,Surgery,Karachi, Sindh, Pakistan 2Aga Khan University Medical College,Radiology,Karachi, Sindh, Pakistan
Introduction:
Appendicoliths are often found to be associated with perforated and gangrenous appendicitis. However, the relationship between appendicoliths and complications of laparoscopic appendectomy has not been studied. The objective was to determine if the presence of appendicolith/s increased the risk of infectious complications in laparoscopic appendectomy.
Methods:
A retrospective case-control study of patients who received a pre-operative abdominal Computed Tomographic (CT) scan and later underwent laparoscopic appendectomy from 01/2008-12/2015 was completed. Occurrence of post-operative infectious complications, namely surgical site infections and intra-abdominal abscesses were noted. Patients were divided into two groups, those with appendicitis and appendicoliths (AA) and those who had appendicitis with no appendicoliths (NA) on CT scan.
Results:
In total, 453 patients who underwent laparoscopic appendectomy and had pre-operative CT scan were included. Of these, 123 (27%) patients were in the AA group while 330 (73%) patients were in the NA group. There were no significant differences between the mean age, gender and presence of comorbid conditions in both groups. Post-operative infectious complications were seen in 18 (4%) patients that were found in a significantly greater proportion of patients of the AA group than of the NA group. [AA vs. NA: 9 (7.3%) vs. 9 (2.7%); p value 0.03]. Odds ratio was calculated to be 2.8 (Confidence interval 1.1-7.2). On multivariable regression analysis, presence of appendicolith was significantly associated with the occurrence of post-operative infectious complications.
Conclusion:
Appendicoliths increase the risk of post-operative infections in patients with appendicitis. For patients diagnosed to have appendicitis with appendicolith, steps to prevent postoperative complications, such as judicious use of post-operative antibiotics, should be considered.