Comparison Of The Effects Of Laparoscopic Appendectomy At Different Time After Antibiotic Treatment Of Suppurative Appendicitis

Objective: To compare the effect of laparoscopic appendectomy at different time after antibiotic treatment of suppurative appendicitis.Methods : 1.From January 2016 to December 2017,the clinical data of 359 patients who underwent laparoscopic appendectomy for suppurative appendicitis in Weihai Municipal hospital were collected.All patients received antibiotic treatment before laparoscopic appendectomy,but the treatment time is different.According to the time from the start of antibiotic treatment to the operation,all patients were divided into group A(< 24 h,n=211),group B(24-48 h,n=38),group C(49-72 h,n=48)and group D(>72h,n=62).The preoperative leucocyte count,neutrophil percentage,operation time,postoperative hospital stay,fever time,the time of antibiotic treatment,retention time of drainage tube,leucocyte count,anal exhaust ratio within 24 hours,positive rate of peritoneal exudate,total hospitalization time,and hospitalization expenses were compared.2.The complication of postoperative endoscopic resection of all patients with acute appendicitis was a dependent variable.Age,symptomatic time,hospitalization time,body temperature at admission,leucocyte count,etc.are independent variables.Univariate and multivariate logistic regression analyses were performed to investigate the association between delays before treatment,postoperative delay,and postoperative outcomes.Results : 1.There was no significant difference between the 4 groups in the operation time,postoperative fever time,retention time of drainage tube,leucocyte count and anal exhaust ratio within 24 hours(P>0.05).In Group D(>72h),the preoperative leucocyte count,neutrophil percentage,postoperative hospital stay,the time of antibiotic treatment,and positive rate of peritoneal exudate were lower than those of the other three groups,but the total hospitalization time and hospitalization expenses were higher than other three groups,the difference was statistically significant(P<0.05).2.Age,symptomatic time,body temperature at admission,leucocyte count,and neutrophil percentage were independent risk factors for complications after laparoscopic appendectomy.Hospitalization time is not a risk factor for postoperative complications.Conclusion: Laparoscopic appendectomy at different time points after antibiotic treatment of suppurative appendicitis has no significant difference in the incidence of postoperative complications,but with the prolonged use of antibiotics,the total hospitalization time and hospitalization costs will be higher.It will increase the medical cost of patients and waste the medical resources,so suppurative appendicitis should be treated as soon as possible.In cases of suspected appendicitis which lack of imaging diagnosis,or cases which emergency surgery cannot be performed due to tomophobia or other objective factors,antibiotics treatment is a feasible option,so that the surgeons can wait for a more appropriate operation time,meanwhile,it will not increase the incidence of complications.