Preventing wound infection after appendicectomy: A review

Abstract

An exponential increase in the number of published prospective studies reflects both a continuing interest in, and a lack of consensus on, the optimal prophylaxis of wound sepsis after appendicectomy. Review of the literature over the last 25 years leads us to emphasize both the importance of adequate study size and of stratification of the severity of the sepsis found at operation. For critical comparison of prophylactic regimens the high percentage of wound infections disclosed after discharge from hospital must be taken into account. Antibiotics reduce the frequency of wound sepsis and although low wound sepsis rates have been reported with systemic antibiotics active against only anaerobes, the cumulative evidence favours a spectrum of antibacterial activity against both aerobic and anaerobic organisms. Topical antiseptics have no significant effect but topical antibiotics are beneficial. Wide variations in outcome for similar antibiotic regimens reflect the importance of technical factors in determining the frequency of wound sepsis.

Pelvic sepsis following laparoscopic appendicectomy versus open appendicectomy: a retrospective study of 648 cases

“…This has been demonstrated for appendicectomies in a number of studies. 8,12,[14][15][16][17][18][19][20][21] The development of pelvic sepsis following appendicectomy is an infrequent but serious complication and can be associated with significant morbidity as well as a second operative procedure, as reported by Krukowski et al 24 Jan et al 20 reports the development of pelvic collections within a week of operative procedure, 20 this is consistent with the timeframe employed in this study. The current literature demonstrates conflicting evidence with some studies suggesting that LA is associated with a higher risk of developing pelvic sepsis, 13,14,18,22 and other studies concluding that this is not significant.…”

Is peritoneal drainage necessary in childhood perforated appendicitis?—A comparative study

“…Some authors reported that an efficient peritoneal debridement and meticulous wound closure would eliminate the need for peritoneal drainage but the use of drains would yield better results in patients with a higher risk of WI and/or fecal fistula [11,12].…”

Evaluation of New Anti-Infective Drugs for Surgical Prophylaxis

“…The use of preoperative antibiotic prophylaxis has reduced the incidence of postoperative infection in this highrisk group to <5% [52,60].…”

“…It appears from these studies that removal ofthe appendix, whatever its pathological state, exposes the patient to inadvertent contamination by bowel flora, thereby raising the risk of postoperative infection. For this reason several authorities have recommended antimicrobial prophylaxis for all operations for acute appendicitis [52,60].…”