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Post-appendectomy wound infection, a solved problem?
C van der Werken1, L P Stassen, J M van Vroonhoven
1Department of Surgery, St.Elisabeth Hospital, Tilburg, The Netherlands.
Abstract:
Over a 3.5 year period, 550 patients underwent an emergency operation under the diagnosis of acute appendicitis. The appendix proved to be normal in 82 patients, the other 468 patients had signs of acute inflammation with perforation in 142 cases. Management followed a strict protocol with single dose metronidazole as preoperative antibiotic prophylaxis and liberal open wound treatment in case of gross contamination. Consequently, the subcutaneous tissues and the skin were left open in 218 patients. The overall wound infection rate (1.3%) and the intra-abdominal abscess rate (1.1%) were extremely low. Open wound treatment was well accepted by the patients, did not prolong the hospital stay and gave good cosmetic results.
Insights
This study on acute appendicitis found that open wound treatment, combined with antibiotic prophylaxis, resulted in very low rates of wound infection and intra-abdominal abscesses. This approach was well-tolerated by patients and yielded good cosmetic outcomes.
Area of Science:
- Surgery
- Infectious Diseases
Background:
- Acute appendicitis is a common surgical emergency.
- Perforation complicates a significant number of appendicitis cases.
- Wound infection and intra-abdominal abscesses are potential complications following appendicitis surgery.
Purpose of the Study:
- To evaluate the efficacy of a specific management protocol for acute appendicitis.
- To assess the rates of wound infection and intra-abdominal abscesses.
- To determine patient acceptance and cosmetic outcomes of open wound treatment.
Main Methods:
- A 3.5-year retrospective review of 550 patients undergoing emergency surgery for acute appendicitis.
- Implementation of a strict protocol including single-dose metronidazole for antibiotic prophylaxis.
- Liberal use of open wound treatment for cases with gross contamination, involving leaving subcutaneous tissues and skin open in 218 patients.
Main Results:
- The overall wound infection rate was 1.3%.
- The intra-abdominal abscess rate was 1.1%.
- Open wound treatment was well accepted, did not prolong hospital stay, and resulted in good cosmetic outcomes.
Conclusions:
- A management protocol involving single-dose metronidazole and open wound treatment is highly effective in minimizing surgical site infections and intra-abdominal abscesses in acute appendicitis.
- Open wound management is a safe and effective strategy for contaminated appendicitis cases, offering good patient acceptance and cosmetic results.