Pediatric Surgery International

, Volume 21, Issue 8, pp 625–630 | Cite as

Primary versus delayed wound closure in complicated appendicitis: an international systematic review and meta-analysis

Original Article

Abstract

The purpose of this study was to determine, by means of a systematic review, whether the method of wound closure in complicated appendicitis affects the incidence of wound infection. A comprehensive literature search of multiple databases including MEDLINE (1980–2003), was performed, using the Cochrane search strategy, for articles on wound closure and complicated appendicitis. Clinical trials examining the method of wound closure were selected for systematic review and all quasi-randomized and randomized trials underwent meta-analysis. Failure to close the wound as planned in delayed closure (DC) was considered indicative of a wound infection. Purulent drainage requiring wound opening indicated an infection in the wounds closed primarily. Six randomized trials were considered adequate for meta-analysis. None independently showed a statistically significant difference in the risk of developing a wound infection with primary closure (PC). When pooled data were subjected to meta-analysis, PC achieved a statistically significant reduction in the relative risk of treatment failure and did not lead to an increase in wound infections. Primary closure does not increase the risk of developing a wound infection after operation for perforated appendicitis. Given the lack of benefit of DC, and the less traumatic, less painful, and less costly nature of PC; primary closure is a safe and practical treatment option.

Keywords

Perforated appendicitis Complicated appendicitis Wound closure Systematic review Meta-analysis 

References

  1. 1.
    Janik JS, Firor HV (1979) Pediatric appendicitis: a 20-year study of 1640 children at Cook County (Illinois) Hospital. Arch Surg 114:717–720PubMedGoogle Scholar
  2. 2.
    Bower RJ, Bell MJ, Ternberg JL (1981) Controversial aspects of appendicitis management in children. Arch Surg 116:885–888PubMedGoogle Scholar
  3. 3.
    Schwartz MZ, Tapper D, Solenberger RI (1983) Management of perforated appendicitis in children: the controversy continues. Ann Surg 197:407–410PubMedCrossRefGoogle Scholar
  4. 4.
    Schwartz SI (1994) Appendix. In: Schwartz SI (ed) Principles of surgery, 6th edn. McGraw-Hill, New York, pp 1307–1318Google Scholar
  5. 5.
    Liu CD, McFadden DW (1997) Acute abdomen and appendix. In: Greenfield LJ (ed) Surgery: scientific principles and practice, 3rd edn. JB Lippincott, Philadelphia, pp 1246–1261Google Scholar
  6. 6.
    Condon RE, Telford GL (1991) Appendicitis. In Sabiston DC (ed) Textbook of surgery, 14th edn. WB Saunders, Philadelphia, pp 884–898Google Scholar
  7. 7.
    David IB, Buck JR, Filler RM (1982) Rational use of antibiotics for perforated appendicitis in childhood. J Pediatr Surg 17:494–500PubMedCrossRefGoogle Scholar
  8. 8.
    Karp MP, Caldarola VA, Cooney DR et al (1986) The avoidable excesses in the management of perforated appendicitis in children. J Pediatr Surg 21:506–511PubMedCrossRefGoogle Scholar
  9. 9.
    Seco JL, Ojeda E, Reguilon C et al (1990) Combined topical and systemic antibiotic prophylaxis in acute appendicitis. Am J Surg 159:226–230PubMedCrossRefGoogle Scholar
  10. 10.
    Burnweit C, Bilik R, Shandling B (2001) Primary closure of contaminated wounds in perforated appendicitis. J Pediatr Surg 26:1362–1365CrossRefGoogle Scholar
  11. 11.
    Neilson IR, Laberge JM, Nguyen LT et al (1990) Appendicitis in children: current therapeutic recommendations. J Pediatr Surg 25:1113–1116CrossRefPubMedGoogle Scholar
  12. 12.
    Curran TJ, Muenchow SK (1993) The treatment of complicated appendicitis in children using peritoneal drainage: results from a public hospital. J Pediatr Surg 28:204–206PubMedCrossRefGoogle Scholar
  13. 13.
    Lund DP, Murphy EU (1994) Management of perforated appendicitis in children: a decade of aggressive treatment. J Pediatr Surg 29:1130–1134CrossRefPubMedGoogle Scholar
  14. 14.
    Keller MS, McBride WJ, Vane DW (1996) Management of complicated appendicitis: a rational approach based on clinical course. Arch Surg 131:261–264PubMedGoogle Scholar
  15. 15.
    Serour F, Efrati Y, Klin B et al (1996) Subcuticular skin closure as a standard approach to emergency appendectomy in children: prospective clinical trial. World J Surg 20:38–42CrossRefPubMedGoogle Scholar
  16. 16.
    Taylor E, Dev V, Shah D et al (2000) Complicated appendicitis: is there a minimum intravenous antibiotic requirement? A prospective randomized trial. Am Surg 66:887–90PubMedGoogle Scholar
  17. 17.
    Emil S, Laberge JM, Mikhail P et al (2003) Appendicitis in children: a ten-year update of therapeutic recommendations. J Pediatr Surg 38:236–42CrossRefPubMedGoogle Scholar
  18. 18.
    Meier DE, Guzzetta PC, Barber RG et al (2003) Perforated appendicitis in children: is there a best treatment? J Pediatr Surg 38:1520–1524CrossRefPubMedGoogle Scholar
  19. 19.
    Chen C, Botelho C, Cooper A et al (2003) Current practice patterns in the treatment of perforated appendicitis in children. J Am Coll Surg 196:212–221CrossRefPubMedGoogle Scholar
  20. 20.
    Newman K, Ponsky T, Kittle K et al (2003) Appendicitis 2000: variability in practice, outcomes, and resource utilization at thirty pediatric hospitals. J Pediatr Surg 38:372–279CrossRefPubMedGoogle Scholar
  21. 21.
    Jadad AR, Moore RA, Carroll D et al (1996) Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Controlled Clin Trials 17:1–12CrossRefPubMedGoogle Scholar
  22. 22.
    Deeks JJ, Altman DG, Bradburn MJ (2001) Statistical methods for examining heterogeneity and combining results from several studies in meta-analysis. In: Egger M, Smith GD, Altman DG (eds) Systematic reviews in health care: meta-analysis in context. BMJ Publishing Group, London, pp 285–312Google Scholar
  23. 23.
    Pettigrew RA (1981) Delayed primary wound closure in gangrenous and perforated appendicitis. Br J Surg 68:635–638PubMedCrossRefGoogle Scholar
  24. 24.
    Tsang TM, Tam PKH, Saing H (1992) Delayed primary wound closure using skin tapes for advanced appendicitis in children. Arch Surg 127:451–453PubMedGoogle Scholar
  25. 25.
    Khammash MR, Ayyash K (1994) Wound infection in primary versus delayed primary wound closure in cases of perforated and gangrenous appendicitis. Saudi Med J 15:408–410Google Scholar
  26. 26.
    Cohn SM, Giannotti G, Ong AW et al (2001) Prospective randomized trial of two wound management strategies for dirty abdominal wounds. Ann Surg 233:409–413CrossRefPubMedGoogle Scholar
  27. 27.
    Chatwiriyacharoen W (2002) Surgical wound infection post surgery in perforated appendicitis in children. J Med Assoc Thai 85:572–576PubMedGoogle Scholar
  28. 28.
    McGreal GT, Joy A, Manning B et al (2002) Antiseptic wick: does it reduce the incidence of wound infection following appendectomy? World J Surg 26:631–634CrossRefPubMedGoogle Scholar
  29. 29.
    Rucinski J, Fabian T, Panagopoulos G et al (2000) Gangrenous and perforated appendicitis: a meta-analytic study of 2532 patients indicates that the incision should be closed primarily. Surgery 127:136–141CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  1. 1.Section of Pediatric SurgeryYale University School of MedicineNew HavenUK

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