Appendectomy Skin Closure Technique, Randomized Controlled Trial: Changing Paradigms (ASC)
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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.
KeywordsAppendicitis Acute Appendicitis Laparoscopic Appendectomy Skin Closure Open Appendectomy
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.
- 2.David H, William S, John S (2007) Appendicitis. Br Med J Clin Evid 7:408Google Scholar
- 5.Andersen BR et al (2001) Review: antibiotics reduce wound infections and intra-abdominal abscesses in patients having appendectomy. Cochrane Database Syst Rev [cited 28 Sep 2014]. Disponible en: http://ebn.bmj.com/content/5/2/49.full.pdf
- 11.Sauerland S, Lefering R, Neugebauer EA (2004) Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev 18(4):84–91Google Scholar
- 16.Sauerland S, Lefering R, Neugebauer EA (2004) Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev [cited 28 Sep 2014]; Disponible en: http://cochrane.bvsalud.org/2007;17:245–55
- 18.Pauniaho SL, Lahdes-Vasama T, Helminen MT et al (1999) Non- absorbable interrupted versus absorbable continuous skin closure in pediatric appendicectomies. Scand J Surg 3:142–146Google Scholar
- 20.Athié GC, Guízar BC, Rivera RH (1999) Epidemiología de la patología abdominal aguda en el servicio de urgencias del Hospital General de México. Análisis de 30 años. Cir Gen 21:99–104Google Scholar
- 21.Chavez Ruiz R, Cano Muñoz I, Flores Gonzalez A, Rodriguez Baca A (2012) Características epidemiológicas en apendicitis aguda: Comparación entre dos poblaciones atendidas en un mismo hospital. Revista Médica MD 3(3):142–147Google Scholar
- 22.Cameron IC, Thomas WEG (2013) Current surgical therapy, 10th edn. Mosby Inc., USA, pp 225–229Google Scholar
- 36.Kadam S, Metha D (2013) Appendicectomy approach: do we choose base don gender and time of day? Int J Surg 11:686–745Google Scholar
- 41.Khajouei H, Afsharfard A, Zeynalzadeh M, Najafbeigi A et al (2007) Cosmetic surgical repair of contaminated wounds versus traditional loose approximation: does it increase the rate of wound infections? MJIRI 20:158–160Google Scholar
- 42.Martínez Ibáñez V (2005) Protocolo de práctica clínica basada en la evidencia. Hospital Vall d’Hebron de BarcelonaGoogle Scholar