To close or not to close? A systematic review and meta-analysis of wound closure in appendicectomy

Abstract

Background/objective: Published studies have shown conflicting results regarding the rate of wound infection between primary and delayed closures in open appendicectomy. This meta-analysis was performed with the aim to summarize all available evidence. Methods: A literature search was carried out using Medline, PubMed, EMBASE and Cochrane databases from inception to January 2018. Randomized controlled studies that compared primary closure (PC) to delayed closure (DC) in appendicectomy were included. Pooled odds ratio and 95% confidence interval were calculated using Mantel-Haenszel fixed-effects model when there was no heterogeneity identified. Results: Of the 471 retrieved studies, eight met the eligibility criteria and were included in the analysis. These trials included 1,263 patients, of whom 623 patients underwent delayed closure and 640 primary closure. Surgical Site Infections SSI rates were not significantly different between the DC and PC groups (16.25% & 12.68% respectively. OR=0.60, 95% CI: 0.23-1.54. There was a high heterogeneity among the analyzed studies (I2=82%). Conclusion: This meta-analysis found no benefit in performing delayed primary closure over primary closure in open appendicectomy. Highlights:

Superficial Surgical Site Infection after Primary Closure Versus Delayed Primary Closure of Wound in Perforated Appendicitis

“…OR=0.60, 95% CI: 0.23-1.54. 10 Wound infection is an extremely cumbersome morbidity for the patients. It not only increases hospital stay but also leads to poor scar and social burden on patients and their family.…”

“…8,9 Several studies and randomized controlled trials (RCTs) have tried to answer this question in the past, with mixed results. 10,11 Meka et al concluded that the risk of SSI in ruptured appendicitis showed no difference between PC and DPC techniques. In low-risk SSI patients, PC does not increase the risk of SSI.…”