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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

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.
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.
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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