Irrigation No Better Than Suction for Perforated Appendicitis

Peritoneal irrigation offers no advantage over suction alone during laparoscopic surgery in children with perforated appendicitis, according to a new study.

Researchers at Children’s Mercy Hospital (Kansas City, MO, USA) conducted a prospective, randomized trial involving 220 children with perforated appendicitis to pertitoneal irrigation with a minimum of 500 cc normal saline or suction only during laparoscopic appendectomy. Perforation was defined as stool in the abdomen or a hole in the appendix. The two groups were well matched with a mean age of 10 years, and both groups had symptoms and temperature of 37.8 °C for three days prior to surgery. All patients underwent a standard three-port appendectomy and postoperative antibiotic regimen.

The results showed outcomes were unchanged when surgeons performed peritoneal irrigation for perforated appendicitis rather than suction alone, with similar rates of abscess, location of abscesses, hospital length of stay (LOS), narcotic doses, and hospital charges when children had peritoneal irrigation or suction alone. Both groups of patients returned to regular diet in 3.5 days, and remained in the hospital 5.5 days. The study was presented at the 132nd annual meeting of the American Surgical Association, held during April 2012 in San Francisco (CA, USA).

“I would say this study is definitive, after 110 observations in each group and absolutely no differences between groups in outcomes, that a moderate volume of saline irrigation does not affect outcome during laparoscopic appendectomy for perforated appendicitis in children,” said lead author pediatric surgeon Shawn St. Peter, MD. “The results, however, cannot be extrapolated to other contaminated cases.”

The debate over irrigation of the peritoneal cavity has gone on for more than a century, with the first reports of irrigation dating back to 1906.

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