Delayed primary closure versus primary closure for wound management in perforated appendicitis: a prospective randomized controlled trial.

BACKGROUND: It is still a matter of debate whether delayed primary closure (DPC) of contaminated abdominal incisions reduces surgical site infections compared with a primary closure (PC). The aim of this study was to determine the optimal method of wound closure for patients with perforated appendicitis. METHODS: A total of 70 patients with perforated appendicitis were included. They were randomized to have their surgical incisions (skin and subcutaneous tissue) either PC or left open with Betadine-soaked gauze packing for DPC on the fifth postoperative day or later if the wound conditions were inappropriate for closure. A wound was considered infected if pus discharged from the incision site. The main outcome measures were the incidence of wound infection and the length of hospital stay (LOS). RESULTS: In the entire series, wound infection developed after incision closure in 21.4% of the patients. The PC group had a higher incidence of wound infection (38.9% vs. 2.9%, p<0.001) and longer LOS (8.4 days vs. 6.3 days, p=0.038). CONCLUSION: Delayed primary closure is the optimal management strategy for perforated appendicitis wounds. It significantly reduces the wound infection rate and length of stay.

Comparison of primary wound closure versus open wound management in perforated appendicitis.

BACKGROUND/PURPOSE: Open wound management has long been the most common practice after appendectomy for perforated appendicitis. Primary closure, however, has recently been advocated to reduce cost and morbidity. The aim of this study was to compare the results of open wound management and primary wound closure in adult patients (age, > or =15 years) with perforated appendicitis. METHODS: Hospital records of 390 patients (age, > or =15 years) who underwent appendectomy between January 2002 and December 2004 were reviewed to identify surgical wound infection (SWI) and pathologic diagnosis. Perforated appendicitis was the indication for appendectomy in 65 of these patients. The incision wounds in these 65 patients were closed primarily in 41 and left open at the end of the operation in 24. The duration of symptoms, white blood cell count, operative time, incidence of SWI, length of stay (LOS) and readmission rate were compared between patients with these two different methods of wound management. RESULTS: Patients whose wounds were closed primarily had a higher incidence of SWI (43.9% vs. 4.2%, p < 0.001) and longer LOS (10 days vs. 7.9 days, p = 0.044). The readmission rate was also higher for patients whose wounds were closed primarily; however, this difference was not significant. CONCLUSION: Open wound management may be preferable to primary wound closure for perforated appendicitis in adults because of a lower incidence of SWI and a shorter LOS. Randomized clinical trials, however, are needed to establish these findings.