Meta-analysis of peritoneal lavage in appendicectomy

Abstract

BackgroundThe use of peritoneal lavage to prevent postoperative intra‐abdominal abscess (IAA) after appendicectomy has been debated widely.MethodsA systematic review and meta‐analysis of suction alone versus lavage for appendicitis was performed to determine the relative benefit of lavage. Primary outcomes were postoperative IAA and wound infection (WI). Inclusion criteria were human studies reporting a comparison of appendicectomy with or without peritoneal lavage.ResultsEight studies met the inclusion criteria, the majority of which were retrospective. Only three were RCTs. Four studies included analysis only of the paediatric population. The rate of IAA was 1·0–19·5 per cent in patients receiving suction alone and 1·5–18·6 per cent in those having lavage. WI rates were 1·0–29·2 per cent for suction alone and 0·8–20·5 per cent for lavage. The pooled risk difference for IAA was 0·01 (95 per cent c.i. −0·03 to 0·06; P = 0·50) and that for WI was 0·00 (−0·05 to 0·05; P = 0·98). Analyses of both outcomes indicated a medium degree of heterogeneity between effect estimates with I 2 values of 71 per cent (P = 0·001) and 70 per cent (P = 0·010) for IAA and WI respectively.ConclusionThere is no evidence of benefit of lavage over suction for postoperative infective complications, and no individual study demonstrated a significant benefit in patients receiving lavage.

Saline irrigation versus gauze wiping and suction only for peritoneal decontamination during laparoscopic repair for perforated peptic ulcer disease

“…However, a few studies have reported that peritoneal irrigation is associated with a high risk of IAA after laparoscopic appendectomy 12 , 33 . A meta-analysis conducted by Gammeri et al demonstrated that there is no evidence of benefit of lavage over suction in the prevention of IAA after appendectomy 34 . Irrigation can possibly be harmful due to the following reasons: First, it may cause diffuse inoculation and spread contamination particularly into the dependent areas (such as the pelvis and subphrenic space) where retrieval can be challenging using a suction probe.…”

Laparoscopic Lavage Versus Suction Only in Complicated Acute Appendicitis: A Prospective Randomized Control Trial

“…This may explain the difference in results obtained by suction only versus lavage. 17,18 Despite the evidence that points toward at best equivalence of lavage and certainly the potential for harm the majority of surgeons still employed irrigation in an attempt to decontaminate the abdomen. Surveys have shown that over 90% of surgeons in the adult and pediatric groups use lavage with complicated appendicitis.…”

Peritoneal antiseptic irrigation to prevent surgical site infection after laparotomy for hepatobiliary or gastrointestinal surgery (PAISI) – Study protocol for a double-blind randomized controlled trial

“…Another meta-analysis from the same year included only 3 RCTs and 5 retrospective analyses comparing suction alone vs. IPI to prevent intraabdominal abscess formation after appendectomy in adults. There was no evidence of bene t of IPI over suction for postoperative infective complications, and no individual study demonstrated a signi cant bene t in patients receiving IPI [19]. One RCT of IPI to prevent SSI after elective liver surgery in 193 patients showed that, when all grades of SSI were considered together, no signi cant difference was evident between lavage (21.9%) and non-lavage groups (13.4%, p=0.135).…”