Copious Irrigation Versus Suction Alone During Laparoscopic Appendectomy for Complicated Appendicitis in Adults

Sun, Fengbo; Wang, He; Zhang, Fengjuan; Zhang, Xinming; Xing, Zhiyuan; Zhang, Shenglin; Zhang, Haifeng; Wang, Ye

doi:10.1080/08941939.2017.1319995

Cited by 22 publications

(36 citation statements)

References 19 publications

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“…Previous studies have suggested that peritoneal irrigation during LA for complicated appendicitis could reduce the incidence of IAA [9,10]. This idea came from the phrase "dilution is the solution to pollution. "…”

Section: Introductionmentioning

confidence: 99%

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Irrigation Versus Suction Alone During Laparoscopic Appendectomy for Uncomplicated Acute Appendicitis

et al. 2020

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Original ArticleAnn Coloproctol 2020;36(1):30-34 https://doi.org/10. 3393/ac.2019.06.25 Purpose: To compare the surgical outcomes of peritoneal irrigation versus suction alone during laparoscopic appendectomy and to identify the risk factors of surgical site infection in patients with uncomplicated acute appendicitis. Methods: Data from patients with uncomplicated acute appendicitis between January 2014 and March 2016 were reviewed. We compared the irrigation and suction alone groups with regard to the following parameters: postoperative complication incidence rate, length of hospital stay, operation time, time to flatus, time to diet commencement, and duration of postoperative antibiotic. Results: A total of 578 patients underwent laparoscopic appendectomy for uncomplicated acute appendicitis. Twenty-five patients were excluded from the analysis because of need for drain insertion, loss to follow-up, simultaneous surgery for another indication, presence of an appendix tumor, or pregnancy. A total of 207 patients (37.4%) had undergone irrigation, and 346 patients (62.6%) received suction alone during laparoscopic appendectomy. The preoperative fever rate was significantly higher in the irrigation group than in the suction alone group. Operative time was also significantly longer in the irrigation group than in the suction alone group (53.8 ± 18.5 minutes vs. 57.8 ± 21.4 minutes, P = 0.027). The postoperative complication rate was higher in the irrigation group than in the suction alone group (4.5% vs. 12.6%, P = 0.001). Multiple logistic regression analysis showed that irrigation and preoperative fever were risk factors for surgical site infection after laparoscopic appendectomy for uncomplicated acute appendicitis. Conclusion: There is no advantage to irrigating the peritoneal cavity over suction alone during laparoscopic appendectomy for uncomplicated acute appendicitis. Irrigation may actually prolong the operative time and therefore be detrimental.

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Section: Introductionmentioning

confidence: 99%

“…The efficacy of irrigation during LA to reduce the risk of IAA remains debatable. A few studies have evaluated the effectiveness of irrigation during LA; however, most focused on complicated appendicitis [9,12]. In addition, there is no evidence for irrigation during LA in uncomplicated appendicitis cases.…”

Section: Introductionmentioning

confidence: 99%

Irrigation Versus Suction Alone During Laparoscopic Appendectomy for Uncomplicated Acute Appendicitis

et al. 2020

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“…The study interval ranged from 1965 to 2016, and thus encompasses the prelaparoscopic era to the present day, including studies from healthcare centres across four continents. Three of the included studies were RCTs; the remainder were retrospective cohort studies. Four studies included analysis only of the paediatric population, two of which were performed entirely using open surgery.…”

Section: Resultsmentioning

confidence: 99%

“…Several RCTs have compared appendicectomy performed with suction alone with various methods of lavage; however, no systematic analysis of such studies has been performed. The aim of this systematic review was to determine the benefit of lavage for appendicitis versus suction alone, focusing particularly on postoperative IAA and WI.…”

Section: Introductionmentioning

confidence: 99%

Meta-analysis of peritoneal lavage in appendicectomy

et al. 2018

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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.

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“…The RCT by Sun et al [6] concludes that irrigation during LA for complicated appendectomy, using at least 2-L normal saline in all four quadrants until no grossly purulent remnants are visible, implying that all the injected fluid is aspirated, reduces IAA incidence, shortens time to first anal exufflation and post-operative stay, and reduces hospital charge. This 348 A. Pasculli et al study has the potential of giving a LoE IB and GoR A, enhancing the process to further meta-analysis, and hopefully new guidelines.…”

Section: Introductionmentioning

confidence: 99%

Irrigation during Laparoscopic Appendectomy for Complicated Appendicitis: Time to Review Current Guidelines

Pasculli

Ferraro

Gurrado

et al. 2017

Journal of Investigative Surgery

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Copious Irrigation Versus Suction Alone During Laparoscopic Appendectomy for Complicated Appendicitis in Adults

Cited by 22 publications

References 19 publications

Irrigation Versus Suction Alone During Laparoscopic Appendectomy for Uncomplicated Acute Appendicitis

Irrigation Versus Suction Alone During Laparoscopic Appendectomy for Uncomplicated Acute Appendicitis

Meta-analysis of peritoneal lavage in appendicectomy

Irrigation during Laparoscopic Appendectomy for Complicated Appendicitis: Time to Review Current Guidelines

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