Irrigation in laparoscopic appendectomy provides no benefit over suction alone for perforated appendicitis [Ann of Surgery]

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Key study points:

1.      There was no difference in post-operative abscess formation when comparing peritoneal irrigation to suction alone during laparoscopic appendectomy in children.

Primer: To date there has been no definitive data in favor of peritoneal irrigation or lavage during perforated appendicitis, but the widespread practice continues though opinions on its efficacy are hotly debated. Futhermore, literature on this practice originates mostly from the open era, and no studies have been conducted with laparoscopic approaches. Thus, a prospective, randomized trial was undertaken comparing peritoneal irrigation to suction alone during laparoscopic appendectomy in children.

This [randomized] study: A total of 220 patients were enrolled between 12/2008 and 07/2011. Patients were younger than 18 years with perforated appendicitis and were randomized to either peritoneal irrigation with minimum of 500ml normal saline or suction only during laparoscopic appendectomy. There were no differences in patient presentation between the two groups. Primary outcome variable examined was post-operative abscess formation. There were no significant differences in abscess rate (19.1% with suction only, 18.3% with irrigation) or duration of hospitalization (5.5+/-3 days with suction only, 5.4+/-2.7 days with irrigation). Mean operative time was reduced with suction only (38.7+/-14.9 minutes) vs with irrigation (42.8+/-16.7 minutes), but was not significant. (P = 0.056). 

In sum: There was no difference appreciated in post-operative abscess formation when comparing peritoneal irrigation to suction alone during laparoscopic appendectomy in children. These results are contrary to the widespread belief that use of irrigation during appendectomy is beneficial. Though no prospective, randomized trials have been done in the endoscopic era, previous studies have also failed to show a benefit to antibiotic impregnanted irrigation in reducing the risk of infectious complications, especially if patients are already receiving systemic antibiotic therapy. Given the results of this study, peritoneal irrigation during laparoscopic appendectomy in children cannot be recommended.

Click to read the study in Annals of Surgery

By AH

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