1
|
Lamm R, Kumar SS, Collings AT, Haskins IN, Abou-Setta A, Narula N, Nepal P, Hanna NM, Athanasiadis DI, Scholz S, Bradley JF, Train AT, Pucher PH, Quinteros F, Slater B. Diagnosis and treatment of appendicitis: systematic review and meta-analysis. Surg Endosc 2023; 37:8933-8990. [PMID: 37914953 DOI: 10.1007/s00464-023-10456-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/07/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND The optimal diagnosis and treatment of appendicitis remains controversial. This systematic review details the evidence and current best practices for the evaluation and management of uncomplicated and complicated appendicitis in adults and children. METHODS Eight questions regarding the diagnosis and management of appendicitis were formulated. PubMed, Embase, CINAHL, Cochrane and clinicaltrials.gov/NLM were queried for articles published from 2010 to 2022 with key words related to at least one question. Randomized and non-randomized studies were included. Two reviewers screened each publication for eligibility and then extracted data from eligible studies. Random effects meta-analyses were performed on all quantitative data. The quality of randomized and non-randomized studies was assessed using the Cochrane Risk of Bias 2.0 or Newcastle Ottawa Scale, respectively. RESULTS 2792 studies were screened and 261 were included. Most had a high risk of bias. Computerized tomography scan yielded the highest sensitivity (> 80%) and specificity (> 93%) in the adult population, although high variability existed. In adults with uncomplicated appendicitis, non-operative management resulted in higher odds of readmission (OR 6.10) and need for operation (OR 20.09), but less time to return to work/school (SMD - 1.78). In pediatric patients with uncomplicated appendicitis, non-operative management also resulted in higher odds of need for operation (OR 38.31). In adult patients with complicated appendicitis, there were higher odds of need for operation following antibiotic treatment only (OR 29.00), while pediatric patients had higher odds of abscess formation (OR 2.23). In pediatric patients undergoing appendectomy for complicated appendicitis, higher risk of reoperation at any time point was observed in patients who had drains placed at the time of operation (RR 2.04). CONCLUSIONS This review demonstrates the diagnosis and treatment of appendicitis remains nuanced. A personalized approach and appropriate patient selection remain key to treatment success. Further research on controversies in treatment would be useful for optimal management.
Collapse
Affiliation(s)
- Ryan Lamm
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Sunjay S Kumar
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
- Thomas Jefferson University, 1015 Walnut Street, 613 Curtis, Philadelphia, PA, 19107, USA.
| | - Amelia T Collings
- Hiram C. Polk, Jr Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Ivy N Haskins
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ahmed Abou-Setta
- Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Nisha Narula
- Department of Surgery, Rutgers, New Jersey Medical School, Newark, NJ, USA
| | - Pramod Nepal
- Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Nader M Hanna
- Department of Surgery, Queen's University, Kingston, ON, Canada
| | | | - Stefan Scholz
- Division of General and Thoracic Pediatric Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joel F Bradley
- Division of General Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Arianne T Train
- Department of Surgery, Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Philip H Pucher
- Department of Surgery, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Francisco Quinteros
- Division of Colorectal Surgery, Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - Bethany Slater
- Division of Pediatric Surgery, University of Chicago Medicine, Chicago, IL, USA
| |
Collapse
|
2
|
Shiihara M, Sudo Y, Matsushita N, Kubota T, Hibi Y, Osugi H, Inoue T. Therapeutic strategy for acute appendicitis based on laparoscopic surgery. BMC Surg 2023; 23:161. [PMID: 37312100 PMCID: PMC10265908 DOI: 10.1186/s12893-023-02070-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 06/04/2023] [Indexed: 06/15/2023] Open
Abstract
PURPOSE The treatment strategies for acute appendicitis differ depending on the facility, and various studies have investigated the usefulness of conservative treatment with antibiotics, laparoscopic surgery, and interval appendectomy (IA). However, although laparoscopic surgery is widely used, the clinical strategy for acute appendicitis, especially complicated cases, remains controversial. We assessed a laparoscopic surgery-based treatment strategy for all patients diagnosed with appendicitis, including those with complicated appendicitis (CA). METHODS We retrospectively analysed patients with acute appendicitis treated in our institution between January 2013 and December 2021. Patients were classified into uncomplicated appendicitis (UA) and CA groups based on computed tomography (CT) findings on the first visit, and the treatment course was subsequently compared. RESULTS Of 305 participants, 218 were diagnosed with UA and 87 with CA, with surgery performed in 159 cases. Laparoscopic surgery was attempted in 153 cases and had a completion rate of 94.8% (145/153). All open laparotomy transition cases (n = 8) were emergency CA surgery cases. No significant differences were found in the incidence of postoperative complications in successful emergency laparoscopic surgeries. In univariate and multivariate analyses for the conversion to open laparotomy in CA, only the number of days from onset to surgery ≥ 6 days was an independent risk factor (odds ratio: 11.80; P < 0.01). CONCLUSION Laparoscopic surgery is preferred in all appendicitis cases, including CA. Since laparoscopic surgery is difficult for CA when several days from the onset have passed, it is necessary that surgeons make an early decision on whether to operate.
Collapse
Affiliation(s)
- Masahiro Shiihara
- Department of Surgery, Kamifukuoka General Hospital, 931 Fukuoka Fujimino-Shi, Saitama, 356-0011, Japan.
| | - Yasuhiro Sudo
- Department of Surgery, Kamifukuoka General Hospital, 931 Fukuoka Fujimino-Shi, Saitama, 356-0011, Japan
| | - Norimasa Matsushita
- Department of Surgery, Kamifukuoka General Hospital, 931 Fukuoka Fujimino-Shi, Saitama, 356-0011, Japan
| | - Takeshi Kubota
- Department of Surgery, Kamifukuoka General Hospital, 931 Fukuoka Fujimino-Shi, Saitama, 356-0011, Japan
| | - Yasuhiro Hibi
- Department of Surgery, Kamifukuoka General Hospital, 931 Fukuoka Fujimino-Shi, Saitama, 356-0011, Japan
| | - Harushi Osugi
- Department of Surgery, Kamifukuoka General Hospital, 931 Fukuoka Fujimino-Shi, Saitama, 356-0011, Japan
| | - Tatsuo Inoue
- Department of Surgery, Kamifukuoka General Hospital, 931 Fukuoka Fujimino-Shi, Saitama, 356-0011, Japan
| |
Collapse
|
3
|
Zhou Q, Meng W, Ren Y, Li Q, Boermeester MA, Nthumba PM, Rickard J, Zheng B, Liu H, Shi Q, Zhao S, Wang Z, Liu X, Luo Z, Yang K, Chen Y, Sawyer RG. Effectiveness of intraoperative peritoneal lavage with saline in patient with intra-abdominal infections: a systematic review and meta-analysis. World J Emerg Surg 2023; 18:24. [PMID: 36991507 DOI: 10.1186/s13017-023-00496-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
Abstract
Background
Intraoperative peritoneal lavage (IOPL) with saline has been widely used in surgical practice. However, the effectiveness of IOPL with saline in patients with intra-abdominal infections (IAIs) remains controversial. This study aims to systematically review randomized controlled trials (RCTs) evaluating the effectiveness of IOPL in patients with IAIs.
Methods
The databases of PubMed, Embase, Web of Science, Cochrane library, CNKI, WanFang, and CBM databases were searched from inception to December 31, 2022. Random-effects models were used to calculate the risk ratio (RR), mean difference, and standardized mean difference. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to rate the quality of the evidence.
Results
Ten RCTs with 1318 participants were included, of which eight studies on appendicitis and two studies on peritonitis. Moderate-quality evidence showed that the use of IOPL with saline was not associated with a reduced risk of mortality (0% vs. 1.1%; RR, 0.31 [95% CI, 0.02–6.39]), intra-abdominal abscess (12.3% vs. 11.8%; RR, 1.02 [95% CI, 0.70–1.48]; I2 = 24%), incisional surgical site infections (3.3% vs. 3.8%; RR, 0.72 [95% CI, 0.18–2.86]; I2 = 50%), postoperative complication (11.0% vs. 13.2%; RR, 0.74 [95% CI, 0.39–1.41]; I2 = 64%), reoperation (2.9% vs. 1.7%; RR,1.71 [95% CI, 0.74–3.93]; I2 = 0%) and readmission (5.2% vs. 6.6%; RR, 0.95 [95% CI, 0.48–1.87]; I2 = 7%) in patients with appendicitis when compared to non-IOPL. Low-quality evidence showed that the use of IOPL with saline was not associated with a reduced risk of mortality (22.7% vs. 23.3%; RR, 0.97 [95% CI, 0.45–2.09], I2 = 0%) and intra-abdominal abscess (5.1% vs. 5.0%; RR, 1.05 [95% CI, 0.16–6.98], I2 = 0%) in patients with peritonitis when compared to non-IOPL.
Conclusion
IOPL with saline use in patients with appendicitis was not associated with significantly decreased risk of mortality, intra-abdominal abscess, incisional surgical site infection, postoperative complication, reoperation, and readmission compared with non-IOPL. These findings do not support the routine use of IOPL with saline in patients with appendicitis. The benefits of IOPL for IAI caused by other types of abdominal infections need to be investigated.
Collapse
|
4
|
Postoperative Antibiotics for Complicated Appendicitis in Children: Piperacillin/Tazobactam versus Ceftriaxone with Metronidazole. J Pediatr Surg 2023; 58:1128-1132. [PMID: 36931937 DOI: 10.1016/j.jpedsurg.2023.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/10/2023] [Indexed: 02/19/2023]
Abstract
INTRODUCTION Recent studies are discordant regarding postoperative use of piperacillin/tazobactam (PT) versus ceftriaxone/metronidazole (CM) for pediatric complicated appendicitis. Some argue that the broader spectrum PT decreases intraabdominal abscess formation; however, antibiotic stewardship, and once-a-day dosing favor CM. We aim to compare outcomes of postoperative antibiotic utilization using a large administrative database. METHODS We queried the Pediatric Health Information System for patients 2-18 years old who underwent laparoscopic appendectomy for complicated appendicitis between 2016 and 2021. Patients were grouped into PT, CM, or other using the first postoperative day antibiotics. Adverse events and antibiotic use trends were evaluated. RESULTS We included 29,015 children from 45 hospitals. CM was used in 51.9% and 31.3% received PT. Wide variation was seen among hospitals with PT use decreasing over the years. Overall rate of abscess was 9.2%. On multivariable regression, PT was associated with higher risk for abscess formation (RR 1.35, 99% CI 1.04-1.75) and readmission (RR 1.38, 99% CI 1.13-1.68) compared to the CM group. However, following adjustment for hospitals with high CM prevalence, these associations were no longer significant. CONCLUSION Postoperative use of PT for complicated appendicitis is associated with higher rates of readmissions and intraabdominal abscess when compared to CM. However, this effect is mitigated when adjusting for common practice patterns. LEVEL OF EVIDENCE Level III. STUDY TYPE Retrospective Comparative Study.
Collapse
|
5
|
Burini G, Cianci MC, Coccetta M, Spizzirri A, Di Saverio S, Coletta R, Sapienza P, Mingoli A, Cirocchi R, Morabito A. Aspiration versus peritoneal lavage in appendicitis: a meta-analysis. World J Emerg Surg 2021; 16:44. [PMID: 34488825 PMCID: PMC8419906 DOI: 10.1186/s13017-021-00391-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/19/2021] [Indexed: 01/07/2023] Open
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; I2 = 74%) and laparoscopic group (RR 1.51, 95% CI 0.73-3.13; I2 = 83%). No statistical significance in reoperation rate in open (RR 1.27, 95% CI 0.04-2.49; I2 = 18%) and laparoscopic group (RR 1.42, 95% CI 0.64-2.49; I2 = 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; I2 = 91%) and the rate of wound infection (MD 1.16, 95% CI 0.56-2.38; I2 = 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.
Collapse
Affiliation(s)
- Gloria Burini
- General and Emergency Surgical Clinic of Ancona, Ancona, Italy
| | - Maria Chiara Cianci
- Department of Pediatric Surgery, Meyer Children’s Hospital, University of Florence, Florence, Italy
| | | | | | - Salomone Di Saverio
- Department of Colorectal Surgery, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ UK
| | - Riccardo Coletta
- Department of Pediatric Surgery, Meyer Children’s Hospital, School of Environment and Life Science, University of Salford, Salford, UK
| | - Paolo Sapienza
- Department of Surgery, University of Rome, Sapienza, Italy
| | - Andrea Mingoli
- Department of Surgery, University of Rome, Sapienza, Italy
| | - Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Antonino Morabito
- Department of Pediatric Surgery, Meyer Children’s Hospital, Department of Neurofarba, University of Florence, Florence, Italy
| |
Collapse
|
6
|
Gordon AJ, Choi JH, Ginsburg H, Kuenzler K, Fisher J, Tomita S. Oral Antibiotics and Abscess Formation After Appendectomy for Perforated Appendicitis in Children. J Surg Res 2020; 256:56-60. [PMID: 32683057 DOI: 10.1016/j.jss.2020.05.082] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 12/13/2022]
|
7
|
Wang B, Shi L, Fu W, Liu T. Effects of Sequence of Irrigation, Suction, and Extraction in Cases of Acute Purulent Appendicitis or Gangrenous Perforated Appendicitis After Laparoscopic Appendectomy. J Laparoendosc Adv Surg Tech A 2020; 31:751-755. [PMID: 32960131 DOI: 10.1089/lap.2020.0610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To evaluate rates of postoperative infection in patients with acute purulent appendicitis or gangrenous perforated appendicitis after laparoscopic appendectomy (LA). Methods: In this retrospective cohort study the medical records of patients who had undergone LA for acute appendicitis at Yijishan Hospital of Wannan Medical College between January 2015 and December 2019 were reviewed. The patients were divided into 2 groups based on the sequential order in which peritoneal irrigation, suction, and extraction of appendix had been performed. In Group 1 peritoneal irrigation and suction had been performed before extraction of the appendix, and in Group 2 they had been performed after extraction of the appendix. Demographic details, surgery duration, time to first flatus, length of hospital stay, total hospitalization expenses, and postoperative complications were analyzed. Results: The final study sample included 571 patients, 116 (20.3%) in Group 1 and 455 (79.7%) in Group 2. There were no significant differences in demographic characteristics, preoperative white blood cell counts, surgery durations, lengths of hospital stay, or total hospitalization expenses between the 2 groups (P > .05). Time to first flatus was significantly shorter in Group 1 (2.1 ± 0.5 days) than in Group 2 (2.3 ± 0.6) (P = .016), and the incidence of surgical wound infection was lower in Group 1 (6.9%) than in Group 2 (14.1%) (P = .038). There were no significant differences in the rates of intra-abdominal abscess, small bowel obstruction, or readmission within 30 days between the 2 groups (P > .05). Conclusion: Patients with acute purulent appendicitis or gangrenous perforated appendicitis are at high risk of surgical wound infection. Peritoneal irrigation and suction before appendix extraction may reduce the incidence of postoperative wound infection.
Collapse
Affiliation(s)
- Bing Wang
- Department of Gastrointestinal Surgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China.,Department of Gastrointestinal Surgery, Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Lianghui Shi
- Department of Gastrointestinal Surgery, Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Weihua Fu
- Department of Gastrointestinal Surgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Tong Liu
- Department of Gastrointestinal Surgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| |
Collapse
|
8
|
Zhou Q, Shi Q, Yu X, Wang Z, Zhang J, Yang N, Wang J, Ma Y, Luo X, Xun Y, Zhao S, Zheng B, Meng W, Yang K, Chen Y, Sawyer R. Effectiveness of intraoperative peritoneal lavage (IOPL) with saline in patient with intra-abdominal infections: a systematic review and meta-analysis protocol. BMJ Open 2020; 10:e036273. [PMID: 32690517 PMCID: PMC7371137 DOI: 10.1136/bmjopen-2019-036273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 03/17/2020] [Accepted: 05/13/2020] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Intra-abdominal infections (IAIs) are common surgical emergencies and cause a significant worldwide burden per year. Since the concept of intraoperative peritoneal lavage (IOPL) was proposed in 1905, it has been widely used in the surgery practice. However, the effectiveness of IOPL in patients with IAIs has always been controversial. Our objective is to identify whether it is beneficial to flush the abdominal cavity with saline in IAIs surgery through a comprehensive systematic review and meta-analysis. METHODS AND ANALYSIS This protocol is reported in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Electronic databases (including the Cochrane library, MEDLINE, EMBASE, Web of Science, etc) and clinical trial registry platforms will be searched from inception to 8 September 2019. Randomised controlled trials, quasi-randomised clinical trials and cohort studies comparing IOPL and suction alone in IAIs will be included. The primary outcomes are mortality and abscess rate. Two independent reviewers will screen literature, collect data and assess risk of bias of included studies. Discussion or a third reviewer will be referred for any disagreements. The Grading of Recommendations Assessment, Development and Evaluation approach will be used to assess the quality of the evidence. We will perform meta-analysis using random-effects model. Subgroup analysis, sensitivity analysis and publication bias will be conducted if data are enough. ETHICS AND DISSEMINATION Ethical approval is not required for this systematic review and meta-analysis protocol. Results of this study will be published in a peer-reviewed journal, presented at relevant conferences and disseminated to local and international policy makers. PROSPERO REGISTRATION NUMBER CRD42019145109.
Collapse
Affiliation(s)
- Qi Zhou
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Lanzhou University, an Affiliate of the Cochrane China Network, Lanzhou, China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou University, Lanzhou, China
| | - Qianling Shi
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
- The First Hospital of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Xuan Yu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Lanzhou University, an Affiliate of the Cochrane China Network, Lanzhou, China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou University, Lanzhou, China
| | - Zijun Wang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Lanzhou University, an Affiliate of the Cochrane China Network, Lanzhou, China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou University, Lanzhou, China
| | - Jingyi Zhang
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Nan Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Lanzhou University, an Affiliate of the Cochrane China Network, Lanzhou, China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou University, Lanzhou, China
| | - Jianjian Wang
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Yanfang Ma
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Xufei Luo
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Yangqin Xun
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Lanzhou University, an Affiliate of the Cochrane China Network, Lanzhou, China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou University, Lanzhou, China
| | - Siya Zhao
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Bobo Zheng
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Wenbo Meng
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Kehu Yang
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Lanzhou University, an Affiliate of the Cochrane China Network, Lanzhou, China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou University, Lanzhou, China
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Lanzhou University, an Affiliate of the Cochrane China Network, Lanzhou, China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou University, Lanzhou, China
| | - Robert Sawyer
- Department of Surgery, Western Michigan University, Kalamazoo, Michigan, USA
- College of Engineering and Applied Sciences, Western Michigan University, Kalamazoo, Michigan, USA
| |
Collapse
|
9
|
|
10
|
Bi LW, Yan BL, Yang QY, Cui HL. Peritoneal irrigation vs suction alone during pediatric appendectomy for perforated appendicitis: A meta-analysis. Medicine (Baltimore) 2019; 98:e18047. [PMID: 31852066 PMCID: PMC6922395 DOI: 10.1097/md.0000000000018047] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND There currently exists no substantial evidence reporting the efficacy of peritoneal irrigation in reducing the incidence of postoperative intra-abdominal abscess in pediatric patients. The purpose of our study was to perform a meta-analysis to compare rates of intra-abdominal abscess after appendectomy between irrigation and suction alone groups. METHODS We identified studies by a systematic search in EMBASE, PubMed, Web of Science, and the Cochrane Library to recognize randomized controlled trials and case control studies from the 1950 to May 2019. We limited the English language studies. We checked the reference list of studies to recognize other potentially qualified trials. We analyzed the merged data with use of the Review Manager 5.3. RESULTS We identified 6 eligible papers enrolling a total of 1633 participants. We found no significant difference in the incidence of postoperative intraabdominal abscess, wound infection, and the length of hospitalization between 2 group, but duration of surgery is longer in irrigation group (MD = 6.76, 95% CI = 4.64 to 8.87, P < .001; heterogeneity, I = 25%, P = .26). CONCLUSION Our meta-analysis did not provide strong evidence allowing definite conclusions to be drawn, but suggested that peritoneal irrigation during appendectomy did not decrease the incidence of postoperative IAA. This meta-analysis also indicated the need for more high-quality trials to identify methods to decrease the incidence of postoperative IAA in pediatric perforated appendicitis patients.Trial registration number Standardization of endoscopic treatment of acute abdomen in children: 14RCGFSY00150.
Collapse
Affiliation(s)
- Le-Wee Bi
- Department of the Graduate School, Tianjin Medical University
| | - Bei-Lei Yan
- Department of the Graduate School, Tianjin Medical University
| | - Qian-Yu Yang
- Department of the Graduate School, Tianjin Medical University
| | - Hua-Lei Cui
- Department of General Surgery, Tianjin Children's Hospital, Tianjin
| |
Collapse
|