Irrigation Versus Suction Alone During Laparoscopic Appendectomy for Uncomplicated Acute Appendicitis

Lee, Tae Gyeong; Nam, Soomin; Lee, Hyung Soon; Lee, Jin Ho; Hong, Young Ki; Kang, Jung Gu

doi:10.3393/ac.2019.06.25

Cited by 7 publications

(3 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The traditional pathophysiology of AA can be applied to patients who require surgical treatment. It has been reported that open surgery increased the incidence of surgical site inflammation [21]. However, our data did not reveal any such findings, although our study only included 33 cases of open surgery.…”

Section: Discussioncontrasting

confidence: 61%

To Reduce the Incidence of Postoperative Intraabdominal Abscess, the Application of Nonoperative Management Should be Circumspect Considering Patient Factors and the Nature of Acute Appendicitis

Lee

Yoon

2022

J Acute Care Surg

View full text Add to dashboard Cite

Purpose: Surgery and nonoperative management (NOM) are the treatment modalities for acute appendicitis (AA). There is little evidence to indicate which treatment method should be performed according to the patient's condition or disease severity, surgical extension, and timing after an appendectomy. This study aimed to evaluate postoperative intra-abdominal abscess (PIAA) associated with these factors.Methods: The medical records of 839 patients who underwent appendectomy after a diagnosis of AA between 2019 and 2020 at Gangneung Asan Medical Centre were reviewed retrospectively. The factors associated with PIAA were evaluated.Results: Postoperative complications occurred in 92 patients. Following appendectomy, 16 (1.9%), 83 (9.9%), and three (0.4%) patients developed PIAA, surgical site infection, and incisional hernia, respectively. The American Society of Anesthesiologists class, complicated appendicitis on preoperative abdominal computed tomography, failure of NOM, and extensive surgery above appendectomy were associated with the development of PIAA. However, a laparoscopic approach, irrigation, indwelling drain, ultrasonic dissection, and use of sterile bags were not associated with the development of PIAA.Conclusion: NOM for some patients with complicated AA is an attractive treatment modality. However, to reduce the incidence of PIAA, the application of NOM should be circumspect considering patient factors and the nature of acute appendicitis. Furthermore, appendectomy should be performed as early as possible for patients not indicated for NOM.

show abstract

Section: Discussioncontrasting

confidence: 61%

To Reduce the Incidence of Postoperative Intraabdominal Abscess, the Application of Nonoperative Management Should be Circumspect Considering Patient Factors and the Nature of Acute Appendicitis

Lee

Yoon

2022

J Acute Care Surg

View full text Add to dashboard Cite

show abstract

“…Extensive attempts have been made to reduce the rate of such complications. For example, some studies advocate using a retrieval bag to prevent direct contact of the inflamed appendix with the incision to decrease the SSI rate ( 17 ). Others support intra-abdominal lavage to reduce the risk of intra-abdominal abscess formation, which further decreases wound infection rate ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

Wound Irrigation Using Wet Gauze May Reduce Surgical Site Infection Following Laparoscopic Appendectomy

et al. 2022

View full text Add to dashboard Cite

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.

show abstract

“…There is no evidence of the benefit of lavage over suction alone for postoperative infective complications 43 , and the insertion of a drain in the abscess cavity is controversial. In fact, there is a significantly longer operative time and a higher postoperative complication rate (surgical site infection/intra-abdominal abscess) in the irrigation group than in the suction-only group after laparoscopic appendicectomy for uncomplicated appendicitis 44 . Peritoneal and wound drains are of no use.…”

Section: Arguments For Interval Appendicectomymentioning

confidence: 94%

Management of appendicitis: appendicectomy, antibiotic therapy, or both?

Weledji¹,

Zisuh²,

Ngounou

2023

Annals of Medicine &Amp; Surgery

View full text Add to dashboard Cite

Introduction: Appendicitis is a global disease with an incidence of 7–12% in the population of the USA and Europe but is low and rising in the developing world. It is the most common acute general surgical emergency, but as no investigation is accurate, the diagnosis has to rely on clinical symptoms and signs and, thus, frequently misdiagnosed. The aim of the study was to debate the arguments for managing appendicitis (operative, nonoperative, or both). Patients and methods: Electronic searches of the MEDLINE (PubMed) database, Cochrane Library, and Science Citation Index were performed to identify original published studies on appendicitis and the pre-COVID-19 (coronavirus disease 2019) and post-COVID-19 management. Relevant articles were searched from relevant chapters in specialized texts, and all have been included. Discussion: There are indications for operative (surgery), nonoperative (antibiotics), or both in the management of acute appendicitis. Although laparoscopic appendicectomy is becoming the gold standard of treatment, knowledge of the pros and cons of this approach versus the open approach is important. The controversy in the management of the appendix mass/abscess between an expedient appendicectomy or a combination of conservative management (antibiotics) and interval appendicectomy remains. Conclusion: Laparoscopic appendicectomy is becoming the gold standard for the treatment of appendicitis. However, the advantages of the innovations in minimally invasive and endoscopic surgery are unlikely to render formal open appendicectomy obsolete. Nonoperative management with antibiotics may suffice in selected cases with uncomplicated appendicitis. It is imperative that patients are counseled appropriately if primary antibiotic treatment is to be routinely offered as first-line therapy.

show abstract

Irrigation Versus Suction Alone During Laparoscopic Appendectomy for Uncomplicated Acute Appendicitis

Cited by 7 publications

References 24 publications

To Reduce the Incidence of Postoperative Intraabdominal Abscess, the Application of Nonoperative Management Should be Circumspect Considering Patient Factors and the Nature of Acute Appendicitis

To Reduce the Incidence of Postoperative Intraabdominal Abscess, the Application of Nonoperative Management Should be Circumspect Considering Patient Factors and the Nature of Acute Appendicitis

Wound Irrigation Using Wet Gauze May Reduce Surgical Site Infection Following Laparoscopic Appendectomy

Management of appendicitis: appendicectomy, antibiotic therapy, or both?

Contact Info

Product

Resources

About