No benefit from irrigation during appendectomy

Irrigating the peritoneal cavity during appendectomy for perforated appendicitis offers no advantage over suction alone, with similar rates of postoperative abscess in children treated using both approaches, according to the findings of a US study.

The researchers also found no difference in how quickly the children began clear liquid ingestion, started a regular diet, or were discharged from hospital.

Overall hospital costs for the operation including either irrigation and suction alone were also similar, the team adds in the Annals of Surgery.

"Although historically favored, there has been little evidence to document benefit from saline irrigation of the abdomen," say Shawn St Peter, from Children's Mercy Hospital in Kansas City, Missouri, USA, and colleagues.

Their findings "continue to confirm the fixed abscess rate in our system when using the definition for perforation as a hole in the appendix or fecalith in the abdomen," they add.

A total of 220 patients with perforated appendicitis aged under 18 years were randomly assigned to either laparoscopic appendectomy with irrigation of the right lower quadrant (with a minimum 500 mL of saline and no maximum; n=110), or to appendectomy with suction alone (n=110). The mean volume of saline used in the irrigation group was 867 mL.

Patients underwent follow up either by telephone or clinic visit at 2-4 weeks after surgery, at which point there was no significant difference in the rate of abscess, at 18.3% in irrigated patients and 19.1% in suction-only patients.

Furthermore, duration of hospitalization did not differ significantly between groups, at 5.4 and 5.5 days for irrigation and suction-only patients, respectively, and nor did mean hospital charges, which were US$ 48,100 (€ 37,327) for both groups. Nor did mean operative time, at 42.8 and 38.7 minutes for irrigation and suction-only procedures, respectively, report the authors.

Although this raw difference in time-favoring operations without irrigation is small, with questionable clinical relevance, remark St Peter et al, "it supports the concept of not performing an extra step in an operation when the data demonstrate that it holds no benefit," they suggest.

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