Page 128 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences

Chapter 7
significant risk factor for abdominal complaints on the long-term after appendectomy that could be identified from our data was female gender. Perforation, intra- and postoperatively scored abdominal abscesses or resection of a normal appendix did not result in an increase of abdominal complaints on the long term. Consistent with Tingstedt et al perforated appendicitis led to significant more outpatients visits and readmissions on the short-term because of nonspecific abdominal complaints. Nevertheless, our study demonstrates that these problems do not result in increased abdominal complaints on the long term. As stated before, women indicated significantly more abdominal complaints than men. This is consistent with most studies investigating the relation between abdominal adhesions and chronic abdominal complaints. It has been well described that female patients are more susceptible to abdominal pain compared to male patients [15-17]. For that reason it is difficult to discriminate between abdominal complaints originating from adhesions and other causes including the female reproductive tract.
Our data demonstrate that in patients who experienced abdominal complaints in the previous 6 months only reoperation within 30 days after initial operation could be pointed out as a risk factor (table 4). Interestingly 70% of these patients underwent one or more additional abdominal operations, which in combination with midline laparotomy are likely to contribute to a decreased digestion subscale score. We think that this finding is important, emphasizing the possible impact on patients’ quality of life. However, these cases are complex and should be left out of consideration when analyzing the effect of appendectomy alone.
In the last decade LA has become the technique of first choice, although different clinical trials demonstrated that the advantages compared to open appendectomy are small and some of little clinical relevance [18, 19]. Only a few studies investigated the long-term results after LA and to our knowledge only one study analyzed quality of life at the long run [20]. In this study no differences regarding quality of life could be identified between OA and LA. However, specific questions of abdominal discomfort were lacking in their analysis. In the present study
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