Factors influencing the outcome of image-guided percutaneous drainage of intra-abdominal abscess after gastrointestinal
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ORIGINAL ARTICLE
Factors influencing the outcome of image-guided percutaneous drainage of intra-abdominal abscess after gastrointestinal surgery Yoshiki Okita • Yasuhiko Mohri • Minako Kobayashi • Toshimitsu Araki Koji Tanaka • Yasuhiro Inoue • Keiichi Uchida • Koichiro Yamakado • Kan Takeda • Masato Kusunoki
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Received: 16 February 2012 / Accepted: 19 July 2012 Ó The Author(s) 2013. This article is published with open access at Springerlink.com
Abstract Purpose To improve the selection of patients for percutaneous abscess drainage (PAD) to treat postoperative intra-abdominal abscess after gastrointestinal surgery, we investigated the factors predictive of outcome. Methods Of 143 consecutive patients with symptomatic postoperative intra-abdominal abscess after a gastrointestinal tract resection, 104 who underwent image-guided PAD as the initial treatment were reviewed. We assessed the possible associations between successful PAD and patient-, abscess-, surgical-, and drainage-related variables, and investigated the success rates of PAD for patients with vs. those without the factors related to successful outcome. Results Based on monitoring for 1 year after PAD, the success rate of this procedure was 85.6 % (89/104). Multivariate analysis revealed that the interval between surgery and the onset of abscess (p = 0.0234) and a single abscess (p = 0.0038) were independently associated with a successful outcome. Single late-onset abscess resolved completely within 10 weeks in 91.4 % of these patients. Conclusions Despite new strategies aimed at preventing surgical site infection, PAD remains an important factor in the postoperative management of gastrointestinal surgery in Japan. Initial recognition of the day of onset and the number of abscesses are important prognostic factors.
Y. Okita (&) Y. Mohri M. Kobayashi T. Araki K. Tanaka Y. Inoue K. Uchida M. Kusunoki Departments of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan e-mail: [email protected] K. Yamakado K. Takeda Department of Radiology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
Keywords Postoperative intra-abdominal abscess Percutaneous abscess drainage CT-guided drainage
Introduction Intra-abdominal abscess is a frequent cause of morbidity and mortality following surgery of the alimentary tract [1, 2]. In the past three decades, advances in image-guided percutaneous abscess drainage (PAD) have provided a safe and effective alternative to surgical drainage [3–7]. Despite the lack of randomized studies comparing percutaneous to surgical drainage, PAD has become a widely accepted treatment for accessible postoperative intra-abdominal abscess, especially in Western countries [8–12]. However, the concepts of treatment for postoperative intra-abdominal abscess after gastrointestinal surgery differ between Japan and Western countries [13]. In Japan, routine abdominal drains are generally placed to facilitate
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