World Journal of Surgery

, Volume 40, Issue 11, pp 2603–2610 | Cite as

Appendectomy Skin Closure Technique, Randomized Controlled Trial: Changing Paradigms (ASC)

  • Luis Angel Medina Andrade
  • Franz Yeudiel Pérez Muñoz
  • María Valeria Jiménez Báez
  • Stephanie Serrano Collazos
  • Maria de los Angeles Martinez Ferretiz
  • Brenda Ruiz
  • Oscar Montes
  • Stephanie Woolf
  • Jessica Gonzalez Noriega
  • Uriel Maldonado Aparicio
  • Israel Gonzalez Gonzalez
Innovative Surgical Techniques Around the World



Appendectomy is the most frequent and urgent gastrointestinal surgery. Overtime, the surgical techniques have been improved upon, in order to reduce complications, get better cosmetic results, and limit the discomfort associated with this procedure, by its high impact in the surgery departments. The traditional skin closure is associated with a poor cosmetic result and it requires stitches removal, alongside the pain associated with this procedure, and no benefits were demonstrated in the literature regarding separated stitches over intradermic stitch. This is a randomized controlled trial, and our objective is to compare two different skin closure techniques in open appendectomy.


A prospective randomized trial method was used, with a total number of 208 patients participating in the study, after acute appendicitis diagnosis in the emergency department. They were randomized into two groups: patients who would receive skin closure with a unique absorbable intradermic stitch (Group A) and another group that would receive the traditional closure technique, consistent in non-absorbable separated stitches (Group B). General characteristics like gender, age, Body Mass Index (BMI), comorbidities, and allergies were registered. Days of Evolution (DOE) until surgery, previous use of antibiotics, complicated or uncomplicated appendicitis, surgical time, and wound complications like skin infection, dehiscence, seroma or abscess were also registered in each case.


8 patients were excluded due to negative appendicitis during surgery and lack of follow-up. Two groups, each containing 100 patients, were formed. General characteristics and parity were compared, and no statistically significant differences were observed. Difference in the surgical time (Group A: 47.35 min vs Group B: 54.13 min, p < .001) and cases with complicated appendicitis (Group A: 58 and Group B:38, p = .005) were found to be statistically significant. Four wound complications were reported, and the incidence of seroma (Group A:0 and Group B:5, p = .02) and abscess (Group A:2 and Group B:8, p = .05) were found to have some statistical significant difference. In a multivariate analysis, a relationship was observed between BMI > 25 kg/m2 and seroma (p = .006), BMI > 25 kg/m2 and abscess (p = .02), surgical time >50 min and seroma (p < .001), >2 DOE and abscess (p = .001), and complicated appendicitis with seroma development (p = .03).


Open appendectomy skin closure with a unique absorbable intradermic stitch is safe, with a reduced seroma and abscess incidence, compared to traditional closure, and an equivalent dehiscence and superficial infection incidence, allowing a lower hospital attention cost and length of hospital stay for treatment of complications. The relative risk of complications with traditional skin closure is 2.91 higher, compared to this new technique.


Appendicitis Acute Appendicitis Laparoscopic Appendectomy Skin Closure Open Appendectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



To SAM GL. for the unconditional support and help in this protocol development. Special thanks to Dr. Gerardo Perez, Dr. Roberto Lope, Dr. Reyes David Coot, Dr. Javier Gonzalez, Dr. Ariel Lozano, Dr. Victor Calao, and Dr. Gustavo Segovia for his contribution to protocol success.

Compliance with ethical standards

Conflict of interest

Authors declare no conflict of interest in the protocol development.


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Copyright information

© Société Internationale de Chirurgie 2016

Authors and Affiliations

  • Luis Angel Medina Andrade
    • 1
  • Franz Yeudiel Pérez Muñoz
    • 1
  • María Valeria Jiménez Báez
    • 2
  • Stephanie Serrano Collazos
    • 1
  • Maria de los Angeles Martinez Ferretiz
    • 1
  • Brenda Ruiz
    • 1
  • Oscar Montes
    • 1
  • Stephanie Woolf
    • 1
  • Jessica Gonzalez Noriega
    • 3
  • Uriel Maldonado Aparicio
    • 3
  • Israel Gonzalez Gonzalez
    • 4
  1. 1.Instituto Mexicano del Seguro Social, Hospital General Regional No. 17, General Surgery DepartmentQuintana Roo UniversityCancúnMexico
  2. 2.Health Research Department, Quintana RooInstituto Mexicano del Seguro SocialCancúnMexico
  3. 3.Hospital General de Zona #1. Instituto Mexicano del Seguro SocialUniversidad Nacional Autónoma de MéxicoLa PazMexico
  4. 4.General Surgery Department, The American British Cowdray Medical Center I.A.PUniversidad Nacional Autonoma de MexicoDistrito FederalMexico

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