Page 121 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences

Long-term follow-up after appendectomy
Introduction
Appendectomy for acute appendicitis is performed over 700.000 times annually in the European Community and accounts for around six percent of all surgical procedures [1, 2]. Perforation (15-25%) and abscess formation (0-5%) are both complications of appendicitis that lead to localized or generalized peritonitis and subsequently induce abdominal adhesion formation [3, 4]. These adhesions may contribute to a higher incidence of small bowel obstruction after complicated appendicitis [5-7]. Other complications of abdominal adhesions consist of infertility, difficulties at reoperations and they are being considered to be associated with chronic abdominal pain [8-10]. Different studies reported postoperative adhesion formation as high as 55-100% of all patients after abdominal surgery [11, 12].
Provided that abdominal adhesions can cause chronic abdominal
pain, one might expect more abdominal complaints after complicated appendicitis. Therefore we designed the present study with long-term follow-up of seven years to investigate whether complicated appendicitis 7 would result in more abdominal complaints than uncomplicated acute appendicitis. In addition, the influence of operation technique (open
versus laparoscopic) was studied. These data might enable us to inform patients about the effect of appendectomy on the long term.
Materials and methods
This study was a retrospective analysis of patients undergoing appendectomies for appendectomy between January 2000 until January 2006 in the Erasmus University Medical Center and the Maasstad Hospital, a large Rotterdam community teaching hospital. Data on demography, clinical presentation, histopathology, operative reports, long-term outcomes and postoperative complications were reviewed. Intraoperative abdominal adhesions were scored when mentioned in the operative report of the appendectomy. The course of acute appendicitis was defined as complicated when perforation and/or abscesses were
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