Abstract
PurposeThis study aimed to compare the perioperative outcomes of wet gauze and conventional irrigation after laparoscopic appendectomy to determine whether wet gauze irrigation can help reduce surgical site infection (SSI).MethodsA total of 308 patients undergoing laparoscopic appendectomy were included in this study between December 2018 and May 2020. Of these, 132 (42.9%) received gauze irrigation (group 1), and 176 patients (57.1%) received conventional irrigation (group 2). Pre-operative outcomes and complications, including SSI, were compared after propensity score matching (PSM) to adjust for baseline differences and selection bias.ResultsAfter 1:1 PSM, 92 well-matched patients in each group were evaluated. Regarding perioperative outcomes between groups 1 and 2, the rate of severe complications (Clavien-Dindo Classification grades III, IV, and V), operative time, and readmission rate did not differ between the groups. Superficial/deep SSIs were observed more frequently in group 2 (8/92 cases) than in group 1 (1/92 cases; p = 0.017). The organ/space SSIs rate was not significantly different between the two groups (1/92 group 1 and 0/92 group 2, p = 0.316). However, post-operative hospital stay was significantly longer in group 2 (2.8 ± 1.3 days) than in group 1 (1.6 ± 1.2 days; p < 0.001). In the univariate analyses, wound irrigation using wet gauze was an independent protective factor for superficial or deep SSI (p = 0.044).ConclusionsWound irrigation using wet gauze after fascia closure has a significant beneficial effect on reducing post-operative superficial/deep SSI following laparoscopic appendectomy.
Highlights
Acute appendicitis is one of the most common causes of emergency abdominal surgery worldwide (1)
Patients who displayed factors that might affect wound healing [older than 75 years, immunocompromising disease, steroid use, American Society of Anesthesiologists (ASA) grade IV, hematologic disorder, previous abdominal operative history, body mass index (BMI) > 30], patients with appendiceal abscess (>4 cm) requiring drainage, phlegmon, or underwent open appendectomy were excluded from this study
CT features such as abscess, extraluminal air, intra- and extraluminal appendicolith, and periappendicular fluid to be defined as complicated acute appendicitis
Summary
Acute appendicitis is one of the most common causes of emergency abdominal surgery worldwide (1). The open approach, which involves a single surgical incision through McBurney point, is the standard of care (2). When compared to minimally invasive techniques, the open approach has the advantages. The open technique is associated with a greater likelihood of wound infection, unfavorable cosmetic outcomes, and a longer post-operative stay (4). Reports showed a marked decrease in the incidence of wound infection from 8.7% with the open approach to
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