Saline vs Tissue Plasminogen Activator Irrigations after Drain Placement for Appendicitis-Associated Abscess: A Prospective Randomized Trial

Peter, Shawn D. St.; Shah, Sohail R.; Adibe, Obinna O.; Sharp, Susan W.; Reading, B.; Cully, B.; Holcomb, George; Rivard, Douglas C.

doi:10.1016/j.jamcollsurg.2015.03.043

Cited by 11 publications

(9 citation statements)

References 20 publications

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“…It required a once a day instillation of tPA via a catheter for three days. This differs from previous studies in which twice a day instillation of a fibrinolytic was performed [1], [3], [6]. In this study the initial drainage involved the infusion of tPA.…”

Section: Discussionmentioning

confidence: 84%

“…The increased drainage resulted in longer hospital stay as this was performed in children. The authors concluded that there was no clinical benefit to use of fibrinolytics administered into appendiceal abscesses [6].…”

Section: Discussionmentioning

confidence: 99%

“…Daily flow rates were not assessed and study sample size was not achieved. The remaining study assessed use of tPA for appendiceal abscesses in children with the authors concluding that there was no clinical benefit to use fibrinolytics administered into appendiceal abscesses [6].…”

Section: Introductionmentioning

confidence: 99%

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A Randomized Prospective Assessment of Safety and Effectiveness of Instillation of Tissue Plasminogen Activator in the Management of Intra-Abdominal Abscesses

Kotecha¹,

Asch²,

Myers³

et al. 2016

OJRad

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Purpose: Catheter drainage of intra-abdominal abscesses has shown to be effective in reducing sepsis and mortality. We sought to determine whether or not tissue plasminogen activator (tPA), a fibrinolytic, is safe and facilitates resolution when used as an adjunct during drainage of intra-abdominal abscesses. Methods: A single-blinded, prospective, multi-center, randomized control trial was performed on patients presenting with image confirmed abscesses; the first group (n = 24) received catheter-directed tPA of their abscess and the second group (n = 23) had their abscess drained without tPA instillation. Variables examined included patient age, gender, location of the abscess, pre-drainage volumes and size of catheters inserted. Baseline variables were compared between tPA and non-tPA groups using a chi-square test for discrete variables and a Wilcoxon rank sum test for continuous variables and for the outcome of drainage volume. Results: Technical success of the drainage procedures was 100% for both groups. The tPA group had higher volume of drainage over the first three days (median for total after 3 days: without tPA: 300 mL vs. with tPA: 322 mL, p = 0.42). At days 4 to 7 the tPA group had significant greater drainage volume than did the non-tPA patient group, 150 mL vs. 110 mL (p = 0.046). The number of days to resume diet was also assessed in the 20 patients where this datum was available, 11 tPA and 9 non-tPA with no difference between groups. No adverse events, such as localized or systemic bleeding were encountered. Conclusion: Instillation of tPA into catheter directed intra-abdominal abscesses was safe, easy to perform and was associated with significantly improved drainage of abscesses from days 4 -7. S. A. Kotecha et al. 203

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

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A Randomized Prospective Assessment of Safety and Effectiveness of Instillation of Tissue Plasminogen Activator in the Management of Intra-Abdominal Abscesses

Kotecha¹,

Asch²,

Myers³

et al. 2016

OJRad

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“…2,8,9 Use of intracavitary tissue plasminogen activator (tPA), a fibrinolytic protease more commonly used intravascularly, 10 facilitates drainage of an abscess by breaking down fibrinous septations. 8,11 In children, the use of tPA is well established in empyema. 11 -13 Its use on an “as-needed” basis in the management of septated intra-abdominal abscesses in children has been shown to be safe.…”

Section: Introductionmentioning

confidence: 99%

“…8,11 In children, the use of tPA is well established in empyema. 11 -13 Its use on an “as-needed” basis in the management of septated intra-abdominal abscesses in children has been shown to be safe. 4 There is no consensus on optimum tPA regimens in abdominal abscesses, in adults or children.…”

Section: Introductionmentioning

confidence: 99%

Use of Tissue Plasminogen Activator in Abdominal Abscesses in Children—A Single-Center Randomized Control Trial

et al. 2020

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Purpose: To establish the efficacy of once-per-day intracavitary tissue plasminogen activator (tPA) in the treatment of pediatric intra-abdominal abscesses. Methods: A single-center prospective, double-blinded, randomized controlled trial of the use of intracavitary tPA in abdominal abscesses in children. Patients were randomized to either tPA-treatment or saline-treatment groups. Primary outcome was drainage catheter dwell (hours). Secondary outcomes were length of hospital stay, times to discharge, clinical and sonographic resolution, and adverse events (AEs). Results: Twenty-eight children were randomized to either group (n = 14 each). Demographics between groups were not significantly different (age P = .28; weight P = .40; gender P = .44). There were significantly more abscesses in the tPA-treated group ( P = .03). Abscesses were secondary to perforated appendicitis (n = 25) or postappendectomy (n = 3). Thirty-four abscesses were drained, 4 aspirated, 3 neither drained/aspirated. There was no significant difference in number of drains ( P = .14), drain size ( P = .19), primary outcome ( P = .077), or secondary outcomes found. No procedural or intervention drug-related AEs occurred. No patient in the saline-treated group required to be switched/treated with tPA. Conclusion: No significant difference in the length of catheter dwell time, procedure time to discharge, or time to resolution was found. Intracavitary tPA was not associated with morbidity or mortality. The results neither support nor negate routine use of tPA in the drainage of intra-abdominal abscess in children. It is possible that a multicentre study with a larger number of patients may answer this question more definitively.

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Scientific surgery

2016

British Journal of Surgery

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Prospective randomized controlled trial comparing the effects of noncontact low-frequency ultrasound with standard care in healing split-thickness donor sites. J Am Coll Surg 2015; 221: 309-318. Twenty-seven patients were randomized, and the active treatment group had at least four ultrasound sessions. Mean time to healing was improved by ultrasound therapy: 12⋅1 versus 21⋅3 days, P = 0⋅04. Bonrath EM, Dedy NJ, Gordon LE, Grantcharov TP. Comprehensive surgical coaching enhances surgical skill in the operating room: a randomized controlled trial. Ann Surg 2015; 262: 205-212.Eighteen surgical trainees had one of two training schedules. Comprehensive coaching improved subsequent procedure-specific skills scores (P = 0⋅017), and reduced the rate of technical surgical error (P = 0⋅003).

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Saline vs Tissue Plasminogen Activator Irrigations after Drain Placement for Appendicitis-Associated Abscess: A Prospective Randomized Trial

Cited by 11 publications

References 20 publications

A Randomized Prospective Assessment of Safety and Effectiveness of Instillation of Tissue Plasminogen Activator in the Management of Intra-Abdominal Abscesses

A Randomized Prospective Assessment of Safety and Effectiveness of Instillation of Tissue Plasminogen Activator in the Management of Intra-Abdominal Abscesses

Use of Tissue Plasminogen Activator in Abdominal Abscesses in Children—A Single-Center Randomized Control Trial

Scientific surgery

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