Vigorous wound irrigation followed by subcuticular skin closure in children with perforated appendicitis

Abstract

Background: Although various protocols for the treatment of children with perforated appendicitis have been established, no one has cited incisional wound irrigation in detail. Material and Method: The records of 69 children undergoing appendectomy for perforated appendicitis between 2004 and 2006 were reviewed. Wound irrigation prior to skin closure using 1-2 liters of normal saline was routinely performed in every case. The treatment protocol includes preoperative and postoperative antibiotic, early appendectomy, copious intraabdominal swab, vigorous wound irrigation and subcuticular skin closure. Either peritoneal lavage or transperitoneal drainage is omitted. Results: Mean patients' age was 8.7 years, 47.8% were girls and there was no death. Subcutaneous fat thickness averaged 1.3 cm. Mean duration of hospitalization was 5.8 days. Of 69 appendectomies, 47 had simple perforation and 22 developed complicated perforation. There were four post-op complications (5.8%). Two patients had very small seroma at the lateral margin of incision, which resolved without additional treatment. One boy developed adhesion obstruction and enterocutaneous fistula, postoperatively. The patient required reoperation and recovered uneventfully. Only one child had wound infection. Conclusion: Vigorous wound irrigation followed by subcuticular skin closure for perforated appendicitis yields an acceptable outcome with low rate of wound complications.