Impacto de la irrigación vs. Succión en la tasa de abscesos postquirúrgicos en apendicectomías laparoscópicas por apendicitis aguda complicadaIsaac Trial

Abstract

In current practice, both the irrigation of the abdominal cavity in laparoscopic appendectomy for complicated acute appendicitis and the simple suction of the material found are carried out equally according to the surgeon performing the surgery. Although it seems that the irrigation is justified in open surgery, and this is supported by numerous publications, we do not find studies in the literature that indicate its use in laparoscopic surgery. The higher the degree of complexity of an acute appendicitis, the higher the probability of intra-abdominal abscess formation in the postoperative period. Of the measures used to prevent abscess formation, such as drainage placement, peritoneal lavage is the least studied. The aims of this study are to determine whether the simple suction of the purulent or fecaloid material found in the abdominal cavity in adults with complicated acute appendicitis is a safe technique and comparable to the irrigation with physiological serum of the abdominal cavity according to the rate of postoperative abscesses; also determine if the abscesses that concur in the Irrigation randomization group occur in regions different than the right lower quadrant, causing difficulty for their treatment; and, finally, determine if among the variables studied there is one or several indicators that help us predict the formation of postoperative abscesses in these patients. To this end, a randomized clinical trial has been conducted in patients undergoing complicated acute appendicitis (defined as perforated appendicitis before or during surgery, gangrenous appendicitis and / or purulent peritonitis). Group A undergoes irrigation of the abdominal cavity with at least 300cc of saline and aspirate. Group B is given the simple suction of the material found. 134 patients were included, of which 66 belong to group A and 68 to group B, with similar demographic characteristics. An abscess rate of 22.4% was found in group A vs. 21% in group B (p = 0.9). No significant differences were found regarding perioperative variables such as surgical time (p = 0.097), postoperative complications (p = 0.613) or hospital stay (p = 0.419). No significant differences were found in terms of location of abscesses in both groups (p = 0.296). Patients who have developed an abscess have more postoperative pain than those who have not developed it (p = 0.019). It is concluded that the simple suction of the found material is a safe technique and does not offer disadvantages regarding the irrigation of the abdominal cavity.