Postoperative Intra-abdominal Abscess Following General Surgery: A Systematic Review of Risk Factors, Prevention, and the Role of Laparotomy.

Postoperative intra-abdominal abscess (PIAA) is a significant complication following general abdominal surgery, contributing to increased morbidity and mortality. This systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, with a comprehensive search of multiple databases including PubMed, Embase, Scopus, and the Cochrane Library up to July 2025. Studies were selected based on predefined PICO (Population, Intervention, Comparison, Outcome) criteria, focusing on adult patients undergoing abdominal surgery and assessing risk factors, prevention, and management strategies for PIAA. Five eligible studies involving 3,537 patients were included and analyzed. Key risk factors identified included perforated appendicitis, intraoperative contamination, elevated National Nosocomial Infections Surveillance (NNIS) scores, preoperative radiation, and splenectomy. Preventive measures such as targeted perioperative antibiotic prophylaxis and selective surgical drainage have demonstrated efficacy in reducing abscess incidence. Percutaneous drainage is generally preferred as the initial intervention due to its minimally invasive nature and favorable outcomes, while laparotomy remains necessary for complex abscesses involving multiloculated collections or anastomotic leaks. The routine use of prophylactic drains remains controversial and may increase postoperative complications. Effective management of PIAA requires careful risk assessment, individualized preventive strategies, and prompt source control. Further well-designed randomized controlled trials are needed to establish standardized treatment protocols and optimize patient outcomes.