The outcome measures of the studies were : Wound infection , intra abdominal abscess , length of stay in hospital , and mortality .
The overall result is that the use of antibiotics is superior to placebo for preventing wound infection and intraabdominal abscess , with no apparent difference in the nature of the removed appendix .
Studies exclusively on children and studies examining topical application reported results in favour to the above , although the results were not significant .
Antibiotic prophylaxis is effective in the prevention of postoperative complications in appendectomised patients , whether the administration is given pre- , peri- or post-operatively , and could be considered for routine in emergency appendectomies
BACKGROUND Appendicitis is the most common cause of acute abdominal pain requiring surgical intervention .
The cause of appendicitis is unclear and the mechanism of pathogenesis continues to be debated .
Despite improved asepsis and surgical techniques , postoperative complications , such as wound infection and intraabdominal abscess , still account for a significant morbidity .
Several studies implicate that postoperative infections are reduced by administration of antimicrobial regimes .
OBJECTIVES This review evaluated the use of antibiotics compared to placebo or no treatment in patients undergoing appendectomy .
Will these patients benefit from antimicrobial prophylaxis ?
Antiseptic wick: Does it reduce the incidence of wound infection following appendectomy?
The role of prophylactic antibiotics is well established for contaminated wounds , but the use of antiseptic wound wicks is controversial . The aim of this work was to study the potential use of wound wicks to reduce the rate of infection following appendectomy . This prospect i ve r and omized controlled clinical trial was conducted at a university hospital in the department of surgery . The subjects were patients undergoing appendectomy for definite acute appendicitis . They were r and omized by computer to primary subcuticular wound closure or use of an antiseptic wound wick . For the latter , ribbon gauze soaked in povidone-iodine was placed between interrupted nylon skin sutures . Wicks were soaked daily and removed on the fourth postoperative day . All patients received antibiotic prophylaxis . They were review ed while in hospital and 4 weeks following operation for evidence of wound infection . The main outcome measures were wound infection , wound discomfort , and cosmetic result . The overall wound infection rate was 8.6 % ( 15/174 ) . In patients with wound wicks it was 11.6 % ( 10/86 ) compared to 5.6 % ( 5/88 ) in those whose wounds were closed by subcuticular sutures ( p = NS ) . We concluded that the use of wound wicks was not associated with decreased wound infection rates following appendectomy . Subcuticular closure is therefore appropriate in view of its greater convenience and safety . RésuméDans les plaies contaminées , le rôle de l’antibioprophylaxie est bien établi mais l’utilisation des pansements antiseptiques reste controversé . Le but de cette étude a été d’évaluer le potentiel d’utilisation de mèches antiseptiques dans la réduction du taux d’infection après appendicectomie . Cette étude , contrôlée par r and omisation , provenant d’un service de chirurgie universitaire , comprend des patients opérés d’appendicectomie pour appendicite aiguë . Les patients ont été r and omisés selon une méthode informatique pour recevoir soit une fermeture sous-cutanée primitive soit l’utilisation d’un pansement antiseptique . Dans ce dernier cas , la plaie a été traitée par un ruban de gaze trempé dans une solution de polividone iodé placé entre des sutures cutanées à points séparés . Les mèches ont été imbibées tous les jours et enlevées au quatrième jour . Tous les patients ont eu une antibioprophylaxie . Tous les patients ont été revus à l’hôpital et quatre semaines après leur sortie . Les critères de jugement ont été : l’infection de la plaie , une gène au niveau de la plaie et l’aspect esthétique . Le taux d’infection global a été de 8.6 % ( 15/174 ) . Chez les patients avec des pansements , ce taux a été de 11.6 % ( 10/86 ) comparé à 5.6 % ( 5/88 ) chez les patients do nt la plaie a été fermée par sutures sous-cutanées ( p = NS ) . L’utilisation de mèches ne diminue pas le taux d’infection de la plaie après apfrendfcectomie . La fermeture sous-cutanée est donc appropriée en vue de son applicabilité et sécurité . ResumenEn heridas contaminadas el papel de la antibioticoprofilaxis está bien definido , pero la introducción dentro de la herida de tiras antisépticas sigue est and o controvertida . El objetivo de este estudio fue valorar la posible utilidad de la colocación de tiras asépticas en la reducción de las infecciones de las heridas operatorias tras apendicectomía . En un departamento quirúrgico de un Hospital Universitario se realizó este estudio prospect ivo r and omizado y controlado . En él se incluyeron todos aquellos pacientes apendicectomizados por padecer una apendicitis aguda verdadera . Los pacientes se r and omizaron mediante ordenador para que en unos , se suturase primariamente el tejido celular subcutáneo y en otro , se empleasen tiras antisépticas . Las tiras de gasa empapadas en povidona yodada se introdujeron entre los puntos entrecortados de piel . Las tiras se empapaban diariamente con povidona yodada y se retiraron al 4 ° día del postoperatorio . Todos los pacientes recibieron antibioticoprofilaxis . Fueron curados y revisados durante su estancia hospitalaria y a las 4 semanas de la operación con objeto de valorar la existencia o no de infección de la herida operatoria . Se evaluaron : la infección de la herida , molestias a su nivel y result ados cosméticos . La incidencia global de infección de la herida operatoria fue del 8.6 % ( 15/174 ) . En pacientes tratados con tiras asépticas alcanzó el 11.6 % ( 10/86 ) mientras que las heridas en las que se suturó el tejido celular subcutáneo el porcentaje de infección fue del 5.6 % ( 15/88 ) p = NS . Tras apendicectomía , la infección de la herida operatoria no disminuyó con un tratamiento de tiras asépticas . La sutura del tejido celular subcutáneo parece ser más conveniente y segura
The outcome measures of the studies were : Wound infection , intra abdominal abscess , length of stay in hospital , and mortality .
The overall result is that the use of antibiotics is superior to placebo for preventing wound infection and intraabdominal abscess , with no apparent difference in the nature of the removed appendix .
Studies exclusively on children and studies examining topical application reported results in favour to the above , although the results were not significant .
Antibiotic prophylaxis is effective in the prevention of postoperative complications in appendectomised patients , whether the administration is given pre- , peri- or post-operatively , and could be considered for routine in emergency appendectomies
BACKGROUND Appendicitis is the most common cause of acute abdominal pain requiring surgical intervention .
The cause of appendicitis is unclear and the mechanism of pathogenesis continues to be debated .
Despite improved asepsis and surgical techniques , postoperative complications , such as wound infection and intraabdominal abscess , still account for a significant morbidity .
Several studies implicate that postoperative infections are reduced by administration of antimicrobial regimes .
OBJECTIVES This review evaluated the use of antibiotics compared to placebo or no treatment in patients undergoing appendectomy .
Will these patients benefit from antimicrobial prophylaxis ?