Aspiration versus peritoneal lavage in appendicitis: a meta-analysis
Gloria Burini, Maria Chiara Cianci, Marco Coccetta, Alessandro Spizzirri, Salomone Di Saverio, Riccardo Coletta, Paolo Sapienza, Andrea Mingoli, Roberto Cirocchi, Antonino Morabito
Abstract
Abstract Background Acute appendicitis is one of the most frequent abdominal surgical emergencies. Intra-abdominal abscess is a frequent post-operative complication. The aim of this meta-analysis was to compare peritoneal irrigation and suction versus suction only when performing appendectomy for complicated appendicitis. Methods According to PRISMA guidelines, a systematic review was conducted and registered into the Prospero register (CRD42020186848). The risk of bias was defined to be from low to moderate. Results Seventeen studies (9 RCTs and 8 CCTs) were selected, including 5315 patients. There was no statistical significance in post-operative intra-abdominal abscess in open (RR 1.27, 95% CI 0.75–2.15; I 2 = 74%) and laparoscopic group (RR 1.51, 95% CI 0.73–3.13; I 2 = 83%). No statistical significance in reoperation rate in open (RR 1.27, 95% CI 0.04–2.49; I 2 = 18%) and laparoscopic group (RR 1.42, 95% CI 0.64–2.49; I 2 = 18%). In both open and laparoscopic groups, operative time was lower in the suction group (RR 7.13, 95% CI 3.14–11.12); no statistical significance was found for hospital stay (MD − 0.39, 95% CI − 1.07 to 0.30; I 2 = 91%) and the rate of wound infection (MD 1.16, 95% CI 0.56–2.38; I 2 = 71%). Conclusions This systematic review has failed to demonstrate the statistical superiority of employing intra-operative peritoneal irrigation and suction over suction-only to reduce the rate of post-operative complications after appendectomy, but all the articles report clinical superiority in terms of post-operative abscess, wound infection and operative times in suction-only group.