Irrigation versus suction alone during laparoscopic appendectomy; A randomized controlled equivalence trial.

Area of Science:

• Surgical Innovation
• Minimally Invasive Surgery
• Gastrointestinal Surgery

Background:

• Laparoscopic appendectomy is a standard procedure for appendicitis.
• The role of operative peritoneal irrigation versus suction alone in managing perforated appendicitis remains debated.
• Previous studies, primarily in children, showed non-significant differences, which do not confirm equivalence.

Purpose of the Study:

• To compare the efficacy of operative peritoneal irrigation versus suction alone during laparoscopic appendectomy in adult patients.
• To determine if these two methods are equivalent in preventing post-operative intra-abdominal abscess.

Main Methods:

• A single-institution, prospective, randomized controlled equivalence study.
• Adult patients with suppurative or perforated appendicitis were randomized to receive either peritoneal irrigation or suction alone.
• The primary endpoint was the rate of post-operative intra-abdominal abscess, analyzed using an unconditional exact test of equivalence.

Main Results:

• Eighty-one patients were analyzed: 40 in the irrigation group and 41 in the suction-only group.
• The rate of post-operative intra-abdominal abscess was 5% (2/40) in the irrigation group and 4.9% (2/41) in the suction-only group.
• The 95% confidence interval for the difference (-0.1200 to 0.1244) fell within the pre-defined equivalence limits (-0.15, 0.15), demonstrating equivalence.

Conclusions:

• Operative peritoneal irrigation and suction alone are equivalent in managing suppurative or perforated appendicitis during laparoscopic appendectomy.
• The rate of post-operative intra-abdominal abscess is similar between the two techniques.
• This finding supports the use of suction alone as a potentially simpler alternative in select cases.