Highlights
- •Withholding irrigation decreased abscess formation from 19.6% to 9.9%, though this did not reach statistical significance.
- •Odds of abscess formation in non-irrigated patients multiplicatively increased 67% for each 6-min increase in operative time.
- •Odds of postoperative abscess formation in non-irrigated patients was 13.4 times greater with operative time ≥60 min.
Abstract
Background
Surgical dogma states that the “solution to pollution is dilution.” We hypothesized
that withholding irrigation during pediatric Single Incision Laparoscopic Surgery
(SILS) appendectomies for perforated appendicitis would decrease postoperative abscess
rate.
Methods
From May 2011 to 5/2015, during SILS appendectomies, saline irrigation and suctioning
was performed. From June 2015 to 8/2021, only suctioning was performed. The operations
and peri-operative management were otherwise identical. We retrospectively reviewed
46 patients in the Irrigation (I) Group and 91 patients in the Non-Irrigation (NI)
Group.
Results
Abscess rate decreased from 19.6% in Group I to 9.9% in Group NI, but this did not
reach statistical significance (p = 0.12). Operative duration was significantly longer
in patients who developed postoperative abscesses in Group NI (odds ratio 1.67, p = 0.002)
and overall (odds ratio 1.45, p = 0.0002).
Conclusions
Withholding irrigation during SILS appendectomies trended toward a decreased postoperative
abscess rate. Increased operative times were associated with postoperative abscess
formation.
Keywords
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Article info
Publication history
Published online: November 15, 2022
Accepted:
November 10,
2022
Received in revised form:
November 6,
2022
Received:
July 23,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
