Simple Ligation of Stump without Embedding Suture during Appendectomy Caused No Increased Complication Rates

PURPOSE: There have been several reports claiming benefits for the simplified method of appendectomy over the traditional method of embedding suture at the stump, without contradictory opinions ever having been published. Nevertheless, most surgeons continue to carry out purse-string sutures in daily practices of open appendectomy as long as the stump situation permits. In case where the cecum near the stump is friably swollen due to the spread of inflammation in advanced appendicitis, we have often faced uncomfortable pulling of cecal stitches during embedding procedures experiencing tearing or incomplete approximation of the pulled wall. To avoid this difficulty and shorten the procedure, we have been performing simple double ligations of the stump and observed the results. METHODS: Prospectively we assigned patients to an operative method of either simple ligations or embedding sutures, alternatively upon admission, and performed this method of stump management with two surgeons for 4 years, and postoperative complications were observed in 362 and 273 cases respectively. RESULTS: There was no advantage of one method over the other in recovery course, and in view of the complication rates associated with stump inadequacy and adhesive ileus, even in cases of perforated appendicitis also. CONCLUSION: When possible, Stump ligations simplify appendectomy procedure without increased operative sequelae, even in cases of perforated appendicitis. So this procedure could be recommended instead of purse-string sutures, especially in cases of thick and friable cecal wall due to acutely disseminated appendiceal inflammation.

Peritoneal Saline Irrigation and Infective Complications in Perforated Appendicitisin at a Single Center

PURPOSE: Until recently, the surgical treatment of perforated appendicitis in South Korea showed a relatively high incidence of postoperative infectious complications compared with centers having protocols for managements. Authors have been performing appendectomies for perforated cases under the principle of massive irrigation of the peritoneal cavity and primary closure of incision wound that leaves a suction drain from pelvic cavity, expecting reducing chance of infective complications and thus reducing the stress faced by operators. METHODS: Among 788 cases of appendicitis from September 1997 to December 2002, 172 patients showing perforation and peritonitis in the operative field were reviewed retrospectively. All the operations were performed by the principle mentioned above, and data were collected on various major complications, especially infective wound and intra-abdominal complications. RESULTS: There were 7 cases of suppurative wound infection, and 5 cases of intra-abdominal abscess, representing a total incidence of 7.0% (n=12) in 172 patients. Other major complications such as adhesive ileus (n=3), intestinal fistula (n=1), or remote organ infective event (n=1) were also recognized. CONCLUSION: Massive saline irrigation during appendectomy of perforated appendicitis-without antibiotic mixture-that leaves a negative suction drain from the pelvic cavity and the primary closure of incision wounds have yielded satisfactory results concerning various aspects, especially in lessening infective postoperative complications.