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Perforated appendicitis: The solution to pollution is not dilution

Published:November 15, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.11.012

      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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