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Peritoneal Irrigation Versus No Irrigation 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*, Charles L Snyder*, Walter S Andrews*, Ronald J Sharp*, J Patrick Murphy*, George W Holcomb, III, Daniel J Ostlie*
Children's Mercy Hospital, Kansas City, MO

OBJECTIVE(S):
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.
METHODS:
Patients with perforated appendicitis were randomized to pertitoneal irrigation with a minimum of 500cc normal saline or suction only during laparoscopic appendectomy. Perforation was defined as a hole in the appendix or fecalith in the abdomen. 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 post-operative management was controlled. Data was analyzed on intention to treat basis.
RESULTS:
220 patients were enrolled between 1/2009 and 7/2011. There were no differences in patient characteristics at presentation (Table 1). There was no difference in abscess rate, length of hospitalization, or total charges (Table 2). Mean operative time was 4 minutes longer with irrigation. Irrigation was felt to be necessary in one case (0.9%) randomized to suction only.
CONCLUSIONS: There is no advantage to irrigation of the peritoneal cavity over suction alone during laparoscopic appendectomy for perforated appendicitis.
Table 1 - Patient Characteristics at Operation
Suction Only(N=110) Irrigation (N=110) P-Value
Age (Yrs)9.7 +/- 3.610.4 +/- 3.80.17
Weight (kg)41.2 +/- 19.841.5 +/- 18.80.92
Gender (% male)59.1%52.7%0.89
Leukocyte count17.1 +/- 5.917.3 +/- 5.00.79

Table 2 - Outcome Data
Suction Only(N=110) Irrigation (N=110) P-Value
Abscess Rate19.1%18.3%1.0
Operative Time (Mins)38.7 +/- 14.942.8 +/- 16.70.056
Postoperative Length of Stay (Days)5.5 +/- 3.05.4 +/- 2.70.93
Hospital Charges (\048.1K +/- 20.1K48.1K +/- 18.2K0.97


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