Aspiration versus peritoneal lavage in appendicitis: a meta-analysis

Area of Science:

• Abdominal Surgery
• Surgical Complications
• Evidence-Based Medicine

Background:

• Acute appendicitis is a common surgical emergency.
• Intra-abdominal abscess is a frequent complication following appendectomy.
• Current surgical practices for complicated appendicitis vary regarding peritoneal lavage.

Purpose of the Study:

• To compare the efficacy of intra-operative peritoneal irrigation and suction versus suction-only in reducing post-operative complications after appendectomy for complicated appendicitis.
• To evaluate the impact of these techniques on intra-abdominal abscess rates, reoperation rates, operative time, hospital stay, and wound infection.
• To synthesize evidence from existing studies through a systematic review and meta-analysis.

Main Methods:

• A systematic review and meta-analysis were conducted following PRISMA guidelines.
• Seventeen studies (9 RCTs, 8 CCTs) involving 5315 patients were included.
• Risk of bias was assessed and found to be low to moderate.

Main Results:

• No statistically significant difference in post-operative intra-abdominal abscess rates was observed between the two groups in either open or laparoscopic appendectomy.
• Reoperation rates also showed no statistical significance between the groups.
• Operative time was significantly lower in the suction-only group for both open and laparoscopic procedures.

Conclusions:

• The meta-analysis did not demonstrate a statistically significant superiority of peritoneal irrigation and suction over suction-only in reducing post-operative complications.
• However, clinical superiority, particularly in terms of reduced post-operative abscess, wound infection, and operative times, was reported for the suction-only group across the included studies.
• Further research may be warranted to clarify the optimal surgical technique for complicated appendicitis.