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Postoperative pancreatic fistula is a common complication of pancreatic surgery. In this trial, patients undergoing pancreatic resection who received pasireotide, a somatostatin analogue, had a decreased occurrence of postoperative pancreatic fistula, leak, or abscess. Although mortality after pancreatectomy has decreased to approximately 2% at high-volume centers, the operative morbidity after these procedures has remained between 30% and 50%. 1 , 2 Postoperative pancreatic fistula, leak, and abscess are complications that result from leakage of pancreatic exocrine secretions at the anastomosis or closure of the pancreatic remnant. Postoperative pancreatic fistula is the most common major complication after pancreatectomy, with reported rates between 10% and 28%. Studies suggest that patients in whom postoperative pancreatic fistula develops have a risk of death that is approximately doubled. 3 , 4 Because of the magnitude of this problem, numerous studies have investigated methods . . .

Background Approximately 30% of appendectomies are for complicated acute appendicitis (CAA). With laparoscopy, the main post-operative complication is deep abscesses (12% of cases of CAA, versus 4% for open surgery). A recent cohort study compared short and long courses of postoperative antibiotic therapy in patients with CAA. There was no significant intergroup difference in the post-operative complication rate (12% of organ/space surgical site infection (SSI)). Moreover, antibiotic therapy is increasingly less indicated for other situations (non-complicated appendicitis, post-operative course of cholecystitis, perianal abscess), calling into question whether post-operative antibiotic therapy is required after laparoscopic appendectomy for CAA. Methods/design This study is a prospective, multicenter, parallel-group, randomized (1:1), double-blinded, placebo-controlled, phase III non-inferiority study with blind evaluation of the primary efficacy criterion. The primary objective is to evaluate the impact of the absence of post-operative antibiotic therapy on the organ/space surgical site infection (SSI) rate in patients presenting with CAA (other than in cases of generalized peritonitis). Patients in the experimental group will receive at least one dose of preoperative and perioperative antibiotic therapy (2 g ceftriaxone by intravenous injection every 24 h up to the operation) and metronidazole (500 mg by intravenous injection every 8 h up to the operation) and, in the post-operative period, a placebo for ceftriaxone (2 g/24 h in one intravenous injection) and a placebo for metronidazole (1500 mg/24 h in three intravenous injections, for 3 days). In the control group, patients will receive at least one dose of preoperative and perioperative antibiotic therapy (2 g ceftriaxone by intravenous injection every 24 h up to the operation) and metronidazole (500 mg by intravenous injection every 8 h up to the operation) and, in the post-operative period, antibiotic therapy (ceftriaxone 2 g/24 h and metronidazole 1500 mg/24 h for 3 days). In the event of allergy to ceftriaxone, it will be replaced by levofloxacin (500 mg/24 h in one intravenous injection, for 3 days). The expected organ space SSI rate is 12% in the population of patients with CAA operated on by laparoscopy. With a non-inferiority margin of 5%, a two-sided alpha risk of 5%, a beta risk of 20%, and a loss-to-follow-up rate of 10%, the calculated sample size is 1476 included patients, i.e., 738 per group. Due to three interim analyses at 10%, 25%, and 50% of the planned sample size, the total sample size increases to 1494 patients (747 per arm). Trial registration Ethical authorization by the Comité de Protection des Personnes and the Agence Nationale de Sécurité du Médicament : ID-RCB 2017-00334-59. Registered on ClinicalTrials.gov ( NCT03688295 ) on 28 September 2018.

The aim of this study was to evaluate prospectively whether laparoscopic (LA) and open appendectomy (OA) are equally safe and feasible in the treatment of pediatric appendicitis. A total of 517 children with acute appendicitis were randomly assigned to undergo LA or OA appendectomy, based on the schedule of the attending surgeon on call. Patient age, sex, postoperative diagnosis, operating time, level of training of surgical resident, length of postoperative hospitalization, and minor and major postoperative complications were recorded. Chi-square analysis and the Student t-test were used for statistical analysis. In all, 376 OA and 141 LA were performed. The two groups were comparable in terms of patient demographics and the incidence of perforated appendicitis. The operative time was also similar (47.3 +/- 19.7 vs 49.9 +/- 12.9 min). The overall incidence of minor or major complications was 11.2% in the OA group and 9.9% in the LA group. Pediatric patients with appendicitis can safely be offered laparoscopic appendectomy without incurring a greater risk for complications. Nevertheless, a higher (but not significantly higher) abscess rate was found in patients with perforated appendicitis who underwent laparoscopy.

BackgroundPatients with complicated appendicitis are more at risk for the occurrence of postoperative intra-abdominal abscesses than patients with uncomplicated appendicitis. Studies comparing laparoscopic and open appendectomy showed limitations and contradictory findings on the incidence of intra-abdominal abscesses after appendicitis, as most of these studies analysed both uncomplicated and complicated appendicitis as one group. The aim of the present study is to investigate the incidence of intra-abdominal abscesses after laparoscopic versus open appendectomy for complicated appendicitis.MethodsA retrospective cohort study was performed over the period January 2009 till May 2020. All patients who had an intra-operative diagnosis of complicated appendicitis (e.g. perforation, necrosis) were included. The outcome measure was the occurrence of intra-abdominal abscesses with a postoperative follow-up of 30 days. Multivariate logistic regression analysis was performed including adjustments for significant confounders.ResultsA total of 900 patients had undergone appendectomy for complicated appendicitis. The majority was operated laparoscopically (78%, n = 705). The incidence of postoperative intra-abdominal abscess was 12.3% in both laparoscopic and open appendectomy groups. On univariable analysis, the postoperative rates of intra-abdominal abscesses between laparoscopic and open appendectomy were not significantly different (odds ratio 1.11, 95% CI [0.67–1.84], p = 0.681).ConclusionThe present study provides evidence that, in current daily practice, intra-abdominal abscess formation remains a common postoperative complication for complicated appendicitis. Nonetheless, no significant difference was found with regard to intra-abdominal abscess formation when comparing laparoscopy with open surgery.

BackgroundPerforated appendicitis is associated with postoperative development of intraperitoneal abscess. Intraperitoneal drain placement during appendectomy is thought to reduce the risk of developing postoperative intraperitoneal abscess. The aim of this study was to determine whether intraperitoneal drainage could reduce the incidence of intraperitoneal abscess formation after laparoscopic appendectomy for perforated appendicitis.MethodsThis is a retrospective study of all patients (aged 7 and above) who were diagnosed with perforated appendicitis and subsequently underwent laparoscopic appendectomy between January 2018 and December 2022 at two government hospitals in the state of Kuwait. Demographic, clinical, and perioperative characteristics were compared between patients who underwent intraoperative intraperitoneal drain placement and those who did not. The primary outcome was the development of postoperative intraperitoneal abscess. Secondary outcomes included overall postoperative complications, superficial surgical site infection (SSI), length of stay (LOS), readmission and postoperative percutaneous drainage.ResultsA total of 511 patients met the inclusion criteria between 2018 and 2022. Of these, 307 (60.1%) underwent intraoperative intraperitoneal drain placement. Patients with and without drains were similar regarding age, sex, and Charlson Comorbidity Index (CCI) (Table 1). The overall rate of postoperative intraperitoneal abscess was 6.1%. Postoperatively, there was no difference in postoperative intraperitoneal abscess formation between patients who underwent intraperitoneal drain placement and those who did not (6.5% vs. 5.4%, p = 0.707). Patients with intraperitoneal drains had a longer LOS (4 [4, 6] vs. 3 [2, 5] days, p < 0.001). There was no difference in the overall complication (18.6% vs. 12.3%, p = 0.065), superficial SSI (2.9% vs. 2.5%, p = 0.791) or readmission rate (4.9% vs. 4.4%, p = 0.835).ConclusionsFollowing laparoscopic appendectomy for perforated appendicitis, intraperitoneal drain placement appears to confer no additional benefit and may prolong hospital stay.

Objective To investigate the impact of peritoneal lavage on the incidence of intra-abdominal abscess (IAA) after laparoscopic appendectomy (LA) in adults with perforated appendicitis. Methods Clinical data from adult patients intraoperatively diagnosed with perforated appendicitis and undergoing LA at the Affiliated Hospital of Qingdao University between January 2020 and January 2025 were retrospectively analyzed. Patients were divided into a no-peritoneal lavage group and a peritoneal lavage group based on whether peritoneal lavage was performed. A total of 128 patients were included, comprising 91 in the no-peritoneal lavage group and 37 in the peritoneal lavage group. Patient demographics were collected, and propensity score matching (PSM) was employed to compare clinical data between groups. Results After PSM, patient demographics showed no significant differences, indicating good balance ( P  > 0.05). There were no statistically significant differences between the two groups regarding operative time, postoperative antibiotic duration, postoperative length of stay(LOS), or postoperative IAA incidence ( P  > 0.05). Conclusion Our findings indicate that compared to suction alone, peritoneal lavage did not reduce the incidence of postoperative IAA in adults undergoing LA for acute perforated appendicitis. There is no evidence that patients benefit from lavage. Prospective multicenter randomized controlled trials are warranted.

Background The clinical outcomes for postoperative complications (PCs) after gastrectomy depend on early diagnosis and intensive treatment. The aim of this study was to investigate the role of C-reactive protein (CRP) as an early predictor of PCs after gastrectomy for gastric cancer. Methods A total of 334 consecutive patients who underwent gastrectomy for gastric cancer in 2014 were enrolled in this study. Blood samples were obtained preoperatively, and at postoperative days 1 and 4 for the measurement of inflammatory markers (white blood cell, neutrophil, and platelet counts, and CRP). Patients were classified into groups of major and minor/no PCs, which were defined as patients with PCs of more than grade III and those with grade I/II or without PCs, respectively, according to the Clavien–Dindo classification. Results Twenty-five patients developed major PCs. The CRP on postoperative day 4 provided superior diagnostic accuracy in predicting major PCs compared to the other systematic inflammatory markers. Multivariate analysis identified a CRP level of 16.8 mg/dl or greater on postoperative day 4 as a significant predictive factor for major PCs. Conclusions Among the various systemic inflammatory markers, CRP on postoperative day 4 is the most reliable predictor of PCs after gastrectomy for gastric cancer.

Background To explore the risk factors of intra-abdominal abscess (IAA) after laparoscopic appendectomy (LA). Methods A total of 839 patients who underwent LA in Nanjing Jiangbei Hospital from July 2021 to November 2024 were retrospectively analyzed, and their clinical data were collected. Through univariate and multivariate analysis, the risk factors affecting the formation of IAA after operation were screened, and the predictive efficacy was evaluated by ROC curve. Results After screening, there were 25 cases with IAA after operation, 741 cases were cured and 73 cases were excluded. Multivariate analysis showed that appendix perforation (OR = 4.763, 95%CI: 1.827 ~ 12.414, P  = 0.001) and operative time (OR = 1.024, 95%CI: 1.002 ~ 1.046, P  = 0.029) were related to the formation of IAA after operation. The area under ROC curve (AUC) of appendix perforation was 0.623, and the operative time was 0.683. Conclusion For patients with LA, perforation of appendix and longer operative time are independent risk factors for the formation of IAA after operation, which can help predict whether IAA will occur after operation.

BackgroundLaparoscopic cholecystectomy (LC) is one of the most commonly performed emergency procedures, with approximately 600,000 patients undergoing the procedure every year in the United States. Although LC is associated with fewer complications when compared with open cholecystectomy, the risk for infectious complications, including surgical site infection and intra-abdominal abscess, remains a significant source of postoperative morbidity. The goal of this study is to determine whether the gallbladder retrieval technique during LC affects risk of infectious complications.Methods and proceduresWe conducted a retrospective comparative study in a minimally invasive surgery high-volume center in Bogota, Colombia. Patients who underwent LC in 2018 to 2020 were identified. The patients were divided into three groups. One group of LC performed using home-made gallbladder retrieval bag (HMGRB), and another group of LC performed using commercial gallbladder retrieval bag (CGRB). The primary outcomes were infectious complications of superficial site infection and intra-abdominal abscess.ResultsA total of 68 (7.58%) patients underwent LC using an HMGRB, and 828 (92.41%) using a CGRB. There was no significant difference in preoperative sepsis, or sex distribution between patient groups. Using t test, we found differences on age distribution among groups (p < 0.01), surgical times (p < 0.01), and length of stay (p = 0.01). When using Chi square, we found differences in Tokyo and Parkland Grading Scale severity (p < 0.01), use of postoperative antibiotics (p < 0.01), and drain use (p < 0.01). Nonetheless, there was no difference in the rate of superficial surgical site infection (p = 0.92).ConclusionHMGRB are not associated with increased risk of postoperative intra-abdominal abscess or superficial surgical site infection in comparison with CGRB but imply longer surgical times and length of stay. The use of HMGRB is safe, feasible, and has lower cost during LC.

Background Postoperative intra-abdominal abscesses (IAA) remain a significant complication after laparoscopic appendectomy for acute appendicitis. This study investigates the roles of the 5-item modified Frailty Index (mFI-5) and Inflammatory Burden Index (IBI) in predicting IAA risk. Methods This retrospective study analyzed elderly patients who underwent laparoscopic appendectomy from 2015 to 2025. Patients were assessed for frailty using mFI-5 and systemic inflammation using IBI. We collected demographic, clinical, and laboratory data, and univariate and multivariate logistic regression were performed to identify risk factors for IAA. A nomogram was developed based on significant variables from the multivariate analysis by R. Results A total of 428 patients were included, with 43 (10.0%) developing IAA. Multivariate analysis revealed that perforated appendicitis (OR: 2.950, 95% CI: 1.210–7.197, P  = 0.017), higher mFI-5 scores (OR: 3.370, 95% CI: 1.956–5.806, P  < 0.001), and elevated IBI values (OR: 1.104, 95% CI: 1.027–1.186, P  = 0.007) were independently associated with IAA. The nomogram, developed from these factors, showed good discriminatory ability with an AUC of 0.776. Conclusions Perforated appendicitis, mFI-5 and IBI are reliable predictors of IAA in elderly patients after laparoscopic appendectomy. The nomogram incorporating these factors can effectively guide clinical decision-making and identify high-risk patients.