Irrigation versus suction alone during laparoscopic appendectomy for perforated appendicitis: A prospective randomized trial

Shawn D. St Peter, Obinna O. Adibe, Corey W. Iqbal, Frankie B. Fike, Susan W. Sharp, David Juang, David Lanning, J. Patrick Murphy, Walter S. Andrews, Ronald J. Sharp, Charles L. Snyder, George W. Holcomb, Daniel J. Ostlie

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

BACKGROUND: The efficacy of irrigating the peritoneal cavity during appendectomy for perforated appendicitis has been debated extensively. To date, prospective comparative data are lacking. Therefore, we conducted a prospective, randomized trial comparing peritoneal irrigation to suction alone during laparoscopic appendectomy in children. METHODS: Children younger than 18 years with perforated appendicitis were randomized to peritoneal irrigation with a minimum of 500 mL normal saline, or suction only during laparoscopic appendectomy. Perforation was defined as a hole in the appendix or fecalith in the abdomen. The primary outcome variable was postoperative abscess. Using a power of 0.8 and alpha of 0.05, a sample size of 220 patients was calculated. A battery-powered laparoscopic suction/irrigator was used in all cases. Pre-and postoperative management was controlled. Data were analyzed on an intention-to-treat basis. RESULTS: A total of 220 patients were enrolled between December 2008 and July 2011. There were no differences in patient characteristics at presentation. There was no difference in abscess rate, which was 19.1% with suction only and 18.3% with irrigation (P = 1.0). Duration of hospitalization was 5.5 ± 3.0 with suction only and 5.4 ± 2.7 days with group (P = 0.93). Mean hospital charges was $48.1K in both groups (P = 0.97). Mean operative time was 38.7 ± 14.9 minutes with suction only and 42.8 ± 16.7 minutes with irrigation (P = 0.056). Irrigation was felt to be necessary in one case (0.9%) randomized to suction only. In the patients who developed an abscess, there was no difference in duration of hospitalization, days of intravenous antibiotics, duration of home health care, or abscess-related charges. CONCLUSIONS: There is no advantage to irrigation of the peritoneal cavity over suction alone during laparoscopic appendectomy for perforated appendicitis. The study was registered with clinicaltrials.gov at the inception of enrollment (NCT00981136).

Original languageEnglish (US)
Pages (from-to)581-585
Number of pages5
JournalAnnals of Surgery
Volume256
Issue number4
DOIs
StatePublished - Oct 1 2012

Fingerprint

Appendectomy
Suction
Appendicitis
Abscess
Peritoneal Lavage
Peritoneal Cavity
Hospitalization
Fecal Impaction
Hospital Charges
Home Care Services
Operative Time
Abdomen
Sample Size
Anti-Bacterial Agents
Delivery of Health Care

Keywords

  • irrigation
  • laparoscopic appendectomy
  • perforated appendicitis

ASJC Scopus subject areas

  • Surgery

Cite this

St Peter, S. D., Adibe, O. O., Iqbal, C. W., Fike, F. B., Sharp, S. W., Juang, D., ... Ostlie, D. J. (2012). Irrigation versus suction alone during laparoscopic appendectomy for perforated appendicitis: A prospective randomized trial. Annals of Surgery, 256(4), 581-585. https://doi.org/10.1097/SLA.0b013e31826a91e5

Irrigation versus suction alone during laparoscopic appendectomy for perforated appendicitis : A prospective randomized trial. / St Peter, Shawn D.; Adibe, Obinna O.; Iqbal, Corey W.; Fike, Frankie B.; Sharp, Susan W.; Juang, David; Lanning, David; Murphy, J. Patrick; Andrews, Walter S.; Sharp, Ronald J.; Snyder, Charles L.; Holcomb, George W.; Ostlie, Daniel J.

In: Annals of Surgery, Vol. 256, No. 4, 01.10.2012, p. 581-585.

Research output: Contribution to journalArticle

St Peter, SD, Adibe, OO, Iqbal, CW, Fike, FB, Sharp, SW, Juang, D, Lanning, D, Murphy, JP, Andrews, WS, Sharp, RJ, Snyder, CL, Holcomb, GW & Ostlie, DJ 2012, 'Irrigation versus suction alone during laparoscopic appendectomy for perforated appendicitis: A prospective randomized trial', Annals of Surgery, vol. 256, no. 4, pp. 581-585. https://doi.org/10.1097/SLA.0b013e31826a91e5
St Peter, Shawn D. ; Adibe, Obinna O. ; Iqbal, Corey W. ; Fike, Frankie B. ; Sharp, Susan W. ; Juang, David ; Lanning, David ; Murphy, J. Patrick ; Andrews, Walter S. ; Sharp, Ronald J. ; Snyder, Charles L. ; Holcomb, George W. ; Ostlie, Daniel J. / Irrigation versus suction alone during laparoscopic appendectomy for perforated appendicitis : A prospective randomized trial. In: Annals of Surgery. 2012 ; Vol. 256, No. 4. pp. 581-585.
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abstract = "BACKGROUND: The efficacy of irrigating the peritoneal cavity during appendectomy for perforated appendicitis has been debated extensively. To date, prospective comparative data are lacking. Therefore, we conducted a prospective, randomized trial comparing peritoneal irrigation to suction alone during laparoscopic appendectomy in children. METHODS: Children younger than 18 years with perforated appendicitis were randomized to peritoneal irrigation with a minimum of 500 mL normal saline, or suction only during laparoscopic appendectomy. Perforation was defined as a hole in the appendix or fecalith in the abdomen. The primary outcome variable was postoperative abscess. Using a power of 0.8 and alpha of 0.05, a sample size of 220 patients was calculated. A battery-powered laparoscopic suction/irrigator was used in all cases. Pre-and postoperative management was controlled. Data were analyzed on an intention-to-treat basis. RESULTS: A total of 220 patients were enrolled between December 2008 and July 2011. There were no differences in patient characteristics at presentation. There was no difference in abscess rate, which was 19.1{\%} with suction only and 18.3{\%} with irrigation (P = 1.0). Duration of hospitalization was 5.5 ± 3.0 with suction only and 5.4 ± 2.7 days with group (P = 0.93). Mean hospital charges was $48.1K in both groups (P = 0.97). Mean operative time was 38.7 ± 14.9 minutes with suction only and 42.8 ± 16.7 minutes with irrigation (P = 0.056). Irrigation was felt to be necessary in one case (0.9{\%}) randomized to suction only. In the patients who developed an abscess, there was no difference in duration of hospitalization, days of intravenous antibiotics, duration of home health care, or abscess-related charges. CONCLUSIONS: There is no advantage to irrigation of the peritoneal cavity over suction alone during laparoscopic appendectomy for perforated appendicitis. The study was registered with clinicaltrials.gov at the inception of enrollment (NCT00981136).",
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T1 - Irrigation versus suction alone during laparoscopic appendectomy for perforated appendicitis

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AU - St Peter, Shawn D.

AU - Adibe, Obinna O.

AU - Iqbal, Corey W.

AU - Fike, Frankie B.

AU - Sharp, Susan W.

AU - Juang, David

AU - Lanning, David

AU - Murphy, J. Patrick

AU - Andrews, Walter S.

AU - Sharp, Ronald J.

AU - Snyder, Charles L.

AU - Holcomb, George W.

AU - Ostlie, Daniel J.

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N2 - BACKGROUND: The efficacy of irrigating the peritoneal cavity during appendectomy for perforated appendicitis has been debated extensively. To date, prospective comparative data are lacking. Therefore, we conducted a prospective, randomized trial comparing peritoneal irrigation to suction alone during laparoscopic appendectomy in children. METHODS: Children younger than 18 years with perforated appendicitis were randomized to peritoneal irrigation with a minimum of 500 mL normal saline, or suction only during laparoscopic appendectomy. Perforation was defined as a hole in the appendix or fecalith in the abdomen. The primary outcome variable was postoperative abscess. Using a power of 0.8 and alpha of 0.05, a sample size of 220 patients was calculated. A battery-powered laparoscopic suction/irrigator was used in all cases. Pre-and postoperative management was controlled. Data were analyzed on an intention-to-treat basis. RESULTS: A total of 220 patients were enrolled between December 2008 and July 2011. There were no differences in patient characteristics at presentation. There was no difference in abscess rate, which was 19.1% with suction only and 18.3% with irrigation (P = 1.0). Duration of hospitalization was 5.5 ± 3.0 with suction only and 5.4 ± 2.7 days with group (P = 0.93). Mean hospital charges was $48.1K in both groups (P = 0.97). Mean operative time was 38.7 ± 14.9 minutes with suction only and 42.8 ± 16.7 minutes with irrigation (P = 0.056). Irrigation was felt to be necessary in one case (0.9%) randomized to suction only. In the patients who developed an abscess, there was no difference in duration of hospitalization, days of intravenous antibiotics, duration of home health care, or abscess-related charges. CONCLUSIONS: There is no advantage to irrigation of the peritoneal cavity over suction alone during laparoscopic appendectomy for perforated appendicitis. The study was registered with clinicaltrials.gov at the inception of enrollment (NCT00981136).

AB - BACKGROUND: The efficacy of irrigating the peritoneal cavity during appendectomy for perforated appendicitis has been debated extensively. To date, prospective comparative data are lacking. Therefore, we conducted a prospective, randomized trial comparing peritoneal irrigation to suction alone during laparoscopic appendectomy in children. METHODS: Children younger than 18 years with perforated appendicitis were randomized to peritoneal irrigation with a minimum of 500 mL normal saline, or suction only during laparoscopic appendectomy. Perforation was defined as a hole in the appendix or fecalith in the abdomen. The primary outcome variable was postoperative abscess. Using a power of 0.8 and alpha of 0.05, a sample size of 220 patients was calculated. A battery-powered laparoscopic suction/irrigator was used in all cases. Pre-and postoperative management was controlled. Data were analyzed on an intention-to-treat basis. RESULTS: A total of 220 patients were enrolled between December 2008 and July 2011. There were no differences in patient characteristics at presentation. There was no difference in abscess rate, which was 19.1% with suction only and 18.3% with irrigation (P = 1.0). Duration of hospitalization was 5.5 ± 3.0 with suction only and 5.4 ± 2.7 days with group (P = 0.93). Mean hospital charges was $48.1K in both groups (P = 0.97). Mean operative time was 38.7 ± 14.9 minutes with suction only and 42.8 ± 16.7 minutes with irrigation (P = 0.056). Irrigation was felt to be necessary in one case (0.9%) randomized to suction only. In the patients who developed an abscess, there was no difference in duration of hospitalization, days of intravenous antibiotics, duration of home health care, or abscess-related charges. CONCLUSIONS: There is no advantage to irrigation of the peritoneal cavity over suction alone during laparoscopic appendectomy for perforated appendicitis. The study was registered with clinicaltrials.gov at the inception of enrollment (NCT00981136).

KW - irrigation

KW - laparoscopic appendectomy

KW - perforated appendicitis

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