Skip to main content

Advertisement

SpringerLink
Log in

Irrigation during laparoscopic appendectomy for complicated appendicitis increases the operative time and reoperation rate: a meta-analysis of randomized clinical trials

  • Review Article
  • Published:
Updates in Surgery Aims and scope Submit manuscript

Abstract

This meta-analysis of randomized clinical trials (RCT) aimed to compare peritoneal irrigation followed by suction with aspiration only during laparoscopic surgery for complicated appendicitis (LA). PRISMA guidelines with the random-effects model were adopted using Review Manager Version 5.3 for pooled estimates. We retained six eligible RCT published between 2012 and 2019. They involved a total of 1019 patients (541 patients in the aspiration group and 478 patients in the irrigation group). Aspiration only during LA is associated with shorter operative time (MD = 8.50 min, 95% CI [− 12.97 to − 4.02], p = 0.0002) and lower reoperation rate (OR = 0.37 95% CI [0.14–0.96], p = 0.04). There was no difference between aspiration group and irrigation group in terms of Intraperitoneal abscess (IPA) (OR = 0.99 95% CI [0.54–1.81], p = 0.95), morbidity rate (OR = 1.14 95% CI [0.44–2.98], p = 0.79), wound infection (OR = 0.94 95% CI [0.20–4.40], p = 0.94), and hospital stay (MD = 0.65 day, 95% CI [− 0.52 to 1.82], p = 0.27). Irrigation during LA prevents post-appendectomy IPA in neither adults nor pediatric patients. However, it lengthens the operative time and involves a higher reoperation rate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

All data generated or analyzed during this study are included in this published article.

References

  1. Téoule P, de Laffolie J, Rolle U, Reissfelder C (2020) Acute appendicitis in childhood and adulthood. Dtsch Arztebl Int 117(45):764–774

    PubMed  PubMed Central  Google Scholar 

  2. Fike FB, Mortellaro VE, Juang D, Sharp SW, Ostlie DJ, Peter SDS (2011) The impact of postoperative abscess formation in perforated appendicitis. J Surg Res 170(1):24–26

    Article  PubMed  Google Scholar 

  3. Platell C, Papadimitriou JM, Hall JC (2000) The influence of lavage on peritonitis1. J Am Coll Surg 191(6):672–680

    Article  CAS  PubMed  Google Scholar 

  4. Hartwich JE, Carter RF, Wolfe L, Goretsky M, Heath K, Peter SDS et al (2013) The effects of irrigation on outcomes in cases of perforated appendicitis in children. J Surg Res 180(2):222–225

    Article  PubMed  Google Scholar 

  5. Mogilner JG, Slijper N, Kandelis E, Sukhotnik I (2007) The management of pediatric appendicitis: an opinion survey of Israeli pediatric surgeons. Harefuah 146(6):414–419

    PubMed  Google Scholar 

  6. Siotos C, Stergios K, Prasath V, Seal SM, Duncan MD, Sakran JV et al (2019) Irrigation versus suction in laparoscopic appendectomy for complicated appendicitis: a meta-analysis. J Surg Res 235:237–243

    Article  PubMed  Google Scholar 

  7. Sardiwalla II, Koto MZ (2018) Laparoscopic lavage versus suction only in complicated acute appendicitis: a prospective randomized control trial. Int Surg 103(7–8):371–377

    Article  Google Scholar 

  8. Page MJ, Moher D, Bossuyt P, Boutron I, Hoffmann T, Mulrow C et al (2021) PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ 372:n160. https://doi.org/10.1136/bmj.n160

    Article  PubMed  PubMed Central  Google Scholar 

  9. Saluja S, Sun T, Mao J, Steigman SA, Oh PS, Yeo HL et al (2018) Early versus late surgical management of complicated appendicitis in children: a statewide database analysis with one-year follow-up. J Pediatr Surg 53(7):1339–1344

    Article  PubMed  Google Scholar 

  10. Nataraja RM, Bandi A, Clarke SA, Haddad MJ (2010) Comparison of intra-abdominal abscess formation following laparoscopic and open appendicectomy in children. J Laparoendosc Adv Surg Tech 20(4):391–394

    Article  Google Scholar 

  11. Campbell MK, Elbourne DR, Altman DG (2004) CONSORT statement: extension to cluster randomized trials. BMJ 328(7441):702–708

    Article  PubMed  PubMed Central  Google Scholar 

  12. Sterne JA, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I et al (2019) RoB 2: a revised tool for assessing risk of bias in randomized trials. BMJ 366:l4898. https://doi.org/10.1136/bmj.l4898

    Article  PubMed  Google Scholar 

  13. Higgins JP, Green S (2008) Cochrane handbook for systematic reviews of interventions. https://doi.org/10.1002/14651858.ED000142

  14. Higgins JP (2011) Cochrane handbook for systematic reviews of interventions. Version 5.1. 0 [updated March 2011]. The Cochrane Collaboration. http://www.cochrane-handb.org

  15. Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5(1):13

    Article  PubMed  PubMed Central  Google Scholar 

  16. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560

    Article  PubMed  PubMed Central  Google Scholar 

  17. Balshem H, Helfand M, Schünemann HJ, Oxman AD, Kunz R, Brozek J et al (2011) GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol 64(4):401–406

    Article  PubMed  Google Scholar 

  18. Gemici E, Bozkurt MA, Sürek A, Seyhun C, Güne ME (2019) Laparoscopic lavage versus aspiration alone in perforated acute appendicitis: a prospective randomized controlled study. Surg Laparosc Endosc Percutan Tech 00(00):4

    Google Scholar 

  19. Snow HA, Choi JM, Cheng MWH, Chan STF (2016) Irrigation versus suction alone during laparoscopic appendectomy; a randomized controlled equivalence trial. Int J Surg 28:91–96

    Article  PubMed  Google Scholar 

  20. Nataraja RM, Panabokke G, Chang AD, Mennie N, Tanny ST, Keys C et al (2019) Does peritoneal lavage influence the rate of complications following pediatric laparoscopic appendicectomy in children with complicated appendicitis? a prospective randomized clinical trial. J Pediatr Surg 54(12):2524–2527

    Article  PubMed  Google Scholar 

  21. St Peter SD, Adibe OO, Iqbal CW, Fike FB, Sharp SW, Juang D et al (2012) Irrigation versus suction alone during laparoscopic appendectomy for perforated appendicitis: a prospective randomized trial. Ann Surg 256(4):581–585

    Article  PubMed  Google Scholar 

  22. Sun F, Wang H, Zhang F, Zhang X, Xing Z, Zhang S et al (2018) Copious irrigation versus suction alone during laparoscopic appendectomy for complicated appendicitis in adults. J Investig Surg 31(4):342–346

    Article  Google Scholar 

  23. Bi L-W, Yan B-L, Yang Q-Y, Cui H-L (2019) Peritoneal irrigation vs suction alone during pediatric appendectomy for perforated appendicitis: a meta-analysis. Medicine 98(50):e18047

    Article  PubMed  PubMed Central  Google Scholar 

  24. St. Peter SD, Holcomb GW (2013) Should peritoneal lavage be used with suction during laparoscopic appendectomy for perforated appendicitis? Adv Surg 47(1):111–118

    Article  PubMed  Google Scholar 

  25. Peter S, David S (2015) Reply to letter: “Irrigation versus suction alone during laparoscopic appendectomy for perforated appendicitis.” Ann Surg 261(4):e98

    Article  Google Scholar 

  26. Chaouch MA, Jerraya H, Dougaz MW, Nouira R, Dziri C (2019) A systematic review of laparoscopic cholecystectomy in situs inversus. J Investig Surg 34:324–333. https://doi.org/10.1080/08941939.2019.1622822

    Article  Google Scholar 

  27. Low ZX, Bonney GK, So JBY, Loh DL, Ng JJ (2019) Laparoscopic versus open appendectomy in pediatric patients with complicated appendicitis: a meta-analysis. Surg Endosc 33(12):4066–4077

    Article  PubMed  Google Scholar 

  28. Krisher SL, Browne A, Dibbins A, Tkacz N, Curci M (2001) Intra-abdominal abscess after laparoscopic appendectomy for perforated appendicitis. Arch Surg 136(4):438–441

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

None.

Funding

None.

Author information

Authors and Affiliations

  1. Department of Surgery, Universitätsmedizin Mannheim, Heidelberg University, Mannheim, Germany

    Hani Oweira, Hazem Elhadedy, Christoph Reissfelder & Nuh Rahberi

  2. Department of Visceral and Digestive Surgery, University of Medicine of Monastir, Monastir University, Monastir, Tunisia

    Mohamed Ali Chaouch

Authors
  1. Hani Oweira
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hazem Elhadedy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christoph Reissfelder
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nuh Rahberi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mohamed Ali Chaouch
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors participated in the study on the conception, design of the research, and acquisition of the data. All the authors validated the final version of the article.

Corresponding author

Correspondence to Mohamed Ali Chaouch.

Ethics declarations

Conflict of interest

No conflict of interest or support to disclose.

Research involving human participants and/or animals and Informed consent

This research involves human participants. It is a retrospective analysis of published cases and did not require informed consent. Ethics approval and consent to participate were not applicable in this review.

Provenance and peer review

Not commissioned, externally peer-reviewed.

Registration and protocol

This review was not registered.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Oweira, H., Elhadedy, H., Reissfelder, C. et al. Irrigation during laparoscopic appendectomy for complicated appendicitis increases the operative time and reoperation rate: a meta-analysis of randomized clinical trials. Updates Surg 73, 1663–1672 (2021). https://doi.org/10.1007/s13304-021-01075-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13304-021-01075-7

Keywords

Search

Navigation