Laparoscopic Lavage Versus Aspiration Alone in Perforated Acute Appendicitis: A Prospective Randomized Controlled Study

Abstract

The optimal method for preventing abscesses in perforated appendicitis is unclear. We compared the efficacy of lavage versus aspiration for periappendicular collections/abscesses in perforated appendicitis. Our study included 286 patients. After the removal of the appendectomy material, those who underwent aspiration without prior lavage were assigned to Group I, whereas those who underwent aspiration after lavage with 500 mL physiological saline were assigned to Group II. The primary outcome measure was postoperative complications. Secondary outcome measures were intraoperative complications, morbidity, and mortality. Group I comprised 174 patients (60 female and 114 male; mean age 34.47±17.40 y), whereas Group II comprised 112 patients (39 female and 73 male; mean age 36.22±18.60 y). The 2 groups were not significantly different in age, hospitalization duration, sex, abscess formation, morbidity, or mortality. Our results demonstrate that aspiration of the surgery area without prior lavage is sufficient and can be safely applied in perforated appendicitis.

Effectiveness of intraoperative peritoneal lavage with saline in patient with intra-abdominal infections: a systematic review and meta-analysis

“…The remaining 44 articles underwent full-text evaluation, and 34 were excluded (Additional file 1 : Table S4). Finally, ten RCTs including 1318 patients were included [ 31 – 40 ]. The PRISMA diagram of the study selection process is shown in Fig.…”

“…Ten RCTs were published from 1982 to 2020, nine were journal papers [ 31 – 38 , 40 ] and one was a doctoral thesis [ 39 ]. Eight RCTs [ 33 – 40 ] focused on appendicitis and two RCTs [ 31 , 32 ] focused on peritonitis caused by perforation or injury to the stomach, duodenum, small intestine, appendix, etc. No studies focused on infectious pancreatitis or fecal peritonitis.…”

“…No studies focused on infectious pancreatitis or fecal peritonitis. Eight RCTs involved adults [ 31 , 32 , 34 – 37 , 39 , 40 ] and two involved children [ 33 , 38 ]. The majority of the patients with peritonitis involved in two RCTs [ 31 , 32 ] were diffuse infections, and the patients with appendicitis involved in eight RCTs were localized infections [ 33 – 40 ].…”

“…Eight RCTs involved adults [ 31 , 32 , 34 – 37 , 39 , 40 ] and two involved children [ 33 , 38 ]. The majority of the patients with peritonitis involved in two RCTs [ 31 , 32 ] were diffuse infections, and the patients with appendicitis involved in eight RCTs were localized infections [ 33 – 40 ]. Peritonitis studies have mainly focused on the outcomes of mortality, intra-abdominal abscess (IAA), incisional surgical site infections (SSI), and postoperative complications.…”

“…Studies on appendicitis not only examine these outcomes, but also evaluate reoperation, readmission, operative time, length of stay, and hospital charges. Eight RCTs performed laparoscopic appendectomy [ 33 – 40 ] and two RCTs performed open surgery [ 31 , 32 ] (Table 1 ). The RoB assessment showed that none of the included RCTs were blinded to participants and personnel.…”