Peritoneal irrigation vs suction alone during pediatric appendectomy for perforated appendicitis

Abstract

Background: There currently exists no substantial evidence reporting the efficacy of peritoneal irrigation in reducing the incidence of postoperative intra-abdominal abscess in pediatric patients. The purpose of our study was to perform a meta-analysis to compare rates of intra-abdominal abscess after appendectomy between irrigation and suction alone groups.Methods: We identified studies by a systematic search in EMBASE, PubMed, Web of Science, and the Cochrane Library to recognize randomized controlled trials and case control studies from the 1950 to May 2019. We limited the English language studies. We checked the reference list of studies to recognize other potentially qualified trials. We analyzed the merged data with use of the Review Manager 5.3.Results: We identified 6 eligible papers enrolling a total of 1633 participants. We found no significant difference in the incidence of postoperative intraabdominal abscess, wound infection, and the length of hospitalization between 2 group, but duration of surgery is longer in irrigation group (MD = 6.76, 95% CI = 4.64 to 8.87, P < .001; heterogeneity, I 2 = 25%, P = .26). Conclusion:Our meta-analysis did not provide strong evidence allowing definite conclusions to be drawn, but suggested that peritoneal irrigation during appendectomy did not decrease the incidence of postoperative IAA. This meta-analysis also indicated the need for more high-quality trials to identify methods to decrease the incidence of postoperative IAA in pediatric perforated appendicitis patients.Trial registration number Standardization of endoscopic treatment of acute abdomen in children: 14RCGFSY00150Abbreviations: CCS = case control study, CI = confidence intervals, IAA = intra-abdominal abscess, MD = mean difference, NOS = Newcastle-Ottawa Quality Assessment Scale, OR = odds ratio, PI = peritoneal irrigation, RCT = randomized controlled trial, SA = suction alone.

Laparoscopic appendectomy for complicated appendicitis in children: does the post-operative peritoneal drain make any difference? A pilot prospective randomised controlled trial

“…The use of peritoneal irrigation stems from an old principle of “dilution is the solution to pollution”. This, however, has been challenged by St Peter et al and a more recent meta-analysis, showing no benefit in preventing post-operative IAC in adults and children [ 12 , 13 ]. In a randomised prospective study conducted at our institution on adults, potential harm was indicated with irrigation [ 14 ].…”

Evaluation of Drain Insertion After Appendicectomy for Complicated Appendicitis: A Systematic Review and Meta-Analysis

“…Irrigation of the peritoneal cavity was found to be an increasing risk of development of the intra-abdominal collection, and the pus can spread during washout from the localized area of infection in the right iliac fossa to the other compartments in the abdomen resulting in generalized peritonitis [ 47 ]. Moreover, a recent systematic review concluded that suction only is not inferior to suction and irrigation in terms of the development of the postoperative collection and the adoption of a suction-only approach may reduce the operative time [ 45 , 48 ]. Assessment of the effect of these known risk factors for the collection was not possible in this review due to the lack of data in the included studies.…”

Aspiration versus peritoneal lavage in appendicitis: a meta-analysis

“…Of them, 30 articles (including duplicated studies, case reports, articles without related data, review and meta-analysis publication) did not meet the inclusion criteria. The full text of 28 papers was reviewed: 11 studies were excluded (Additional file 2 : Table S1) [ 19 , 38 – 47 ] and 17 were selected for the meta-analysis [ 4 , 6 , 8 , 10 , 48 – 60 ], according to PRISMA flow diagram (Fig. 1 ).…”

“…Post-operative IAA is associated with [ 1 , 18 ] significant morbidity, patient discomfort, prolonged hospital stay and increased cost, often necessitating readmission and repeat intervention [ 7 , 19 – 22 ].…”