Standardized irrigation technique reduces intraabdominal abscess after appendectomy

Melanie B. LaPlant, Daniel A. Saltzman, Jocelyn I. Rosen, Robert D. Acton, Bradley J. Segura, Donavon J. Hess

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Purpose: The utility of irrigation at the time of appendectomy for acute appendicitis has been debated, with recent studies showing no benefit to irrigation. In our practice, two techniques have been used; one in which irrigation was at the discretion of the surgeon, and one in which irrigation was standardized. The standardized irrigation technique involved large volume (3–12 l) irrigation in small, focused, directed aliquots to achieve optimal dilution. We sought to retrospectively assess whether the standardized large volume irrigation technique was associated with measurably reduced intraabdominal infection. We hypothesized that there would be no difference in intraabdominal infection rate. Methods: Medical records for cases of appendectomies performed for acute appendicitis, years 2007 through 2017, were reviewed (n = 432). Rate of subsequent abdominal infection was compared between patients who underwent the standardized large volume irrigation technique compared to those who did not using Fisher's exact test; p < 0.05 was considered significant. Results: For patients that underwent the standardized large volume irrigation technique there were no (0/140) subsequent abdominal infections within the study period, compared with a rate of 6.2% (18/292) for all other patients (p value 0.001). Among cases that had a perforated appendix (n = 105), the rates were 0% (0/31) compared to 18.9% (14/74; p value 0.009). Conclusions: Utilization of a standardized large volume irrigation technique with the objective of serial dilution is associated with a significantly lower rate of subsequent abdominal infection, even among cases with a perforated appendix. Prospective studies are needed to evaluate this technique. Level of Evidence: Level III. Type of study: Treatment study.

Original languageEnglish (US)
Pages (from-to)728-732
Number of pages5
JournalJournal of Pediatric Surgery
Volume54
Issue number4
DOIs
StatePublished - Apr 2019

Fingerprint

Appendectomy
Abscess
Intraabdominal Infections
Appendicitis
Infection
Medical Records
Prospective Studies
Therapeutics

Keywords

  • Appendectomy
  • Appendicitis
  • Irrigation
  • Pediatric
  • Peritoneal lavage

Cite this

Standardized irrigation technique reduces intraabdominal abscess after appendectomy. / LaPlant, Melanie B.; Saltzman, Daniel A.; Rosen, Jocelyn I.; Acton, Robert D.; Segura, Bradley J.; Hess, Donavon J.

In: Journal of Pediatric Surgery, Vol. 54, No. 4, 04.2019, p. 728-732.

Research output: Contribution to journalArticle

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abstract = "Purpose: The utility of irrigation at the time of appendectomy for acute appendicitis has been debated, with recent studies showing no benefit to irrigation. In our practice, two techniques have been used; one in which irrigation was at the discretion of the surgeon, and one in which irrigation was standardized. The standardized irrigation technique involved large volume (3–12 l) irrigation in small, focused, directed aliquots to achieve optimal dilution. We sought to retrospectively assess whether the standardized large volume irrigation technique was associated with measurably reduced intraabdominal infection. We hypothesized that there would be no difference in intraabdominal infection rate. Methods: Medical records for cases of appendectomies performed for acute appendicitis, years 2007 through 2017, were reviewed (n = 432). Rate of subsequent abdominal infection was compared between patients who underwent the standardized large volume irrigation technique compared to those who did not using Fisher's exact test; p < 0.05 was considered significant. Results: For patients that underwent the standardized large volume irrigation technique there were no (0/140) subsequent abdominal infections within the study period, compared with a rate of 6.2{\%} (18/292) for all other patients (p value 0.001). Among cases that had a perforated appendix (n = 105), the rates were 0{\%} (0/31) compared to 18.9{\%} (14/74; p value 0.009). Conclusions: Utilization of a standardized large volume irrigation technique with the objective of serial dilution is associated with a significantly lower rate of subsequent abdominal infection, even among cases with a perforated appendix. Prospective studies are needed to evaluate this technique. Level of Evidence: Level III. Type of study: Treatment study.",
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AU - LaPlant, Melanie B.

AU - Saltzman, Daniel A.

AU - Rosen, Jocelyn I.

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AU - Segura, Bradley J.

AU - Hess, Donavon J.

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N2 - Purpose: The utility of irrigation at the time of appendectomy for acute appendicitis has been debated, with recent studies showing no benefit to irrigation. In our practice, two techniques have been used; one in which irrigation was at the discretion of the surgeon, and one in which irrigation was standardized. The standardized irrigation technique involved large volume (3–12 l) irrigation in small, focused, directed aliquots to achieve optimal dilution. We sought to retrospectively assess whether the standardized large volume irrigation technique was associated with measurably reduced intraabdominal infection. We hypothesized that there would be no difference in intraabdominal infection rate. Methods: Medical records for cases of appendectomies performed for acute appendicitis, years 2007 through 2017, were reviewed (n = 432). Rate of subsequent abdominal infection was compared between patients who underwent the standardized large volume irrigation technique compared to those who did not using Fisher's exact test; p < 0.05 was considered significant. Results: For patients that underwent the standardized large volume irrigation technique there were no (0/140) subsequent abdominal infections within the study period, compared with a rate of 6.2% (18/292) for all other patients (p value 0.001). Among cases that had a perforated appendix (n = 105), the rates were 0% (0/31) compared to 18.9% (14/74; p value 0.009). Conclusions: Utilization of a standardized large volume irrigation technique with the objective of serial dilution is associated with a significantly lower rate of subsequent abdominal infection, even among cases with a perforated appendix. Prospective studies are needed to evaluate this technique. Level of Evidence: Level III. Type of study: Treatment study.

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