J Minim Invasive Surg.  2020 Mar;23(1):43-48. 10.7602/jmis.2020.23.1.43.

Unmodifiable Clinicopathological Risk Factors of Shoulder Tip or Subcostal Pain after Laparoscopic Appendectomy

• Kim B
• Kim J
• Park I
• Cho H
• Gwak G
• Yang KH
• Bae BN
• Kim K

• KMID: 2502939
• DOI: http://doi.org/10.7602/jmis.2020.23.1.43

Abstract

Purpose
Appendectomy, which comprises most benign intra-abdominal surgeries, is currently assisted by laparoscopy in most cases. However, many patients complain of postoperative shoulder or subcostal pain after laparoscopic surgery. In some cases, the pain lasts even several weeks after surgery. This study aimed to analyze unmodifiable clinicopathological factors of patients who underwent laparoscopic appendectomy and to minimize preoperative and postoperative discomfort.
Methods
Patients admitted for laparoscopic appendectomy for acute appendicitis with an American Society of Anesthesiology (ASA) grades I and II, and ages 12~70 years were enrolled in the study. Postoperative shoulder or subcostal pain was assessed using the visual analogue scale (VAS) for pain and analyzed with the clinicopathological factors of the patients, including age, sex, weight, height, body mass index (BMI), and abdominal circumference (AC) difference.
Results
Of the 124 patients, 40 complained of postoperative shoulder or subcostal pain with a VAS score of ≥4. The risk of the postoperative shoulder or subcostal pain increased in women (p=0.001). From a univariate analysis, the risk of postoperative shoulder or subcostal pain increased with lower height, weight and BMI (p=0.002, p=0.001, p=0.012) and with greater AC difference (p=0.012). However, a multivariate analysis showed that lower weight was the only risk factor of postoperative pain (p=0.005).
Conclusion
The risk of postoperative shoulder or subcostal pain after laparoscopic appendectomy was significantly increased with lower weight.

Keyword

Appendectomy; Laparoscopic; Pneumoperitoneum; Shoulder pain