Irrigation Versus Suction in Laparoscopic Appendectomy for Complicated Appendicitis: A Meta-Analysis

Charalampos Siotos, Konstantinos Stergios, Vishnu Prasath, Stella M. Seal, Mark D. Duncan, Joseph Sakran, Mehran Habibi

Research output: Contribution to journalReview article

Abstract

Background: Acute appendicitis is currently one of the most common surgical emergencies. Intra-abdominal abscesses (IAA) are a fearsome complication, which may occur. Irrigation during the appendectomy is one of the factors suggested to affect the rates of IAA. We sought to investigate the evidence regarding the use of irrigation versus suction alone and the development of IAA after laparoscopic appendectomy for complicated appendicitis. Methods: We searched PubMed, Scopus, Embase, Cochrane, and the Web of Science through November 10, 2017, according to Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. We extracted information of interest, including rates of postoperative (IAA), and performed meta-analysis using random-effects model using the RevMan software. Results: We identified five eligible studies with 2511 patients in total. Use of irrigation overall did not demonstrate significant increase in IAA (odds ratio [OR] = 2.39, 95% confidence interval [CI; 0.49, 11.74], P = 0.28). For the adult subpopulation, the use of irrigation was associated with nonsignificant lower odds of IAAs (OR = 0.42, 95% CI [0.15, 1.16]), whereas in pediatric with nonsignificant higher risk (OR = 2.98, 95% CI [0.25, 35.34]). Performance of irrigation led to the addition of, on average, 7 min to the duration of the operation (mean difference = 7.16, 95% CI [3.23, 11.09], P < 0.001). Irrigation did not affect postoperative length of stay (mean difference = −0.80, 95% CI [−2.30, 0.69], P = 0.29). Conclusions: Performance of irrigation during laparoscopic appendectomy does not seem to prevent the development of IAA in neither adults nor pediatric patients.

LanguageEnglish (US)
Pages237-243
Number of pages7
JournalJournal of Surgical Research
Volume235
DOIs
StatePublished - Mar 1 2019

Fingerprint

Abdominal Abscess
Appendectomy
Suction
Appendicitis
Meta-Analysis
Odds Ratio
Pediatrics
PubMed
Length of Stay
Emergencies
Software
Guidelines
Confidence Intervals

Keywords

  • Abscesses
  • Appendectomy
  • Irrigation
  • Meta-analysis
  • Systematic review

ASJC Scopus subject areas

  • Surgery

Cite this

Irrigation Versus Suction in Laparoscopic Appendectomy for Complicated Appendicitis : A Meta-Analysis. / Siotos, Charalampos; Stergios, Konstantinos; Prasath, Vishnu; Seal, Stella M.; Duncan, Mark D.; Sakran, Joseph; Habibi, Mehran.

In: Journal of Surgical Research, Vol. 235, 01.03.2019, p. 237-243.

Research output: Contribution to journalReview article

Siotos, Charalampos ; Stergios, Konstantinos ; Prasath, Vishnu ; Seal, Stella M. ; Duncan, Mark D. ; Sakran, Joseph ; Habibi, Mehran. / Irrigation Versus Suction in Laparoscopic Appendectomy for Complicated Appendicitis : A Meta-Analysis. In: Journal of Surgical Research. 2019 ; Vol. 235. pp. 237-243.
@article{1e72d5a701eb4199b25746b41bf58af6,
title = "Irrigation Versus Suction in Laparoscopic Appendectomy for Complicated Appendicitis: A Meta-Analysis",
abstract = "Background: Acute appendicitis is currently one of the most common surgical emergencies. Intra-abdominal abscesses (IAA) are a fearsome complication, which may occur. Irrigation during the appendectomy is one of the factors suggested to affect the rates of IAA. We sought to investigate the evidence regarding the use of irrigation versus suction alone and the development of IAA after laparoscopic appendectomy for complicated appendicitis. Methods: We searched PubMed, Scopus, Embase, Cochrane, and the Web of Science through November 10, 2017, according to Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. We extracted information of interest, including rates of postoperative (IAA), and performed meta-analysis using random-effects model using the RevMan software. Results: We identified five eligible studies with 2511 patients in total. Use of irrigation overall did not demonstrate significant increase in IAA (odds ratio [OR] = 2.39, 95{\%} confidence interval [CI; 0.49, 11.74], P = 0.28). For the adult subpopulation, the use of irrigation was associated with nonsignificant lower odds of IAAs (OR = 0.42, 95{\%} CI [0.15, 1.16]), whereas in pediatric with nonsignificant higher risk (OR = 2.98, 95{\%} CI [0.25, 35.34]). Performance of irrigation led to the addition of, on average, 7 min to the duration of the operation (mean difference = 7.16, 95{\%} CI [3.23, 11.09], P < 0.001). Irrigation did not affect postoperative length of stay (mean difference = −0.80, 95{\%} CI [−2.30, 0.69], P = 0.29). Conclusions: Performance of irrigation during laparoscopic appendectomy does not seem to prevent the development of IAA in neither adults nor pediatric patients.",
keywords = "Abscesses, Appendectomy, Irrigation, Meta-analysis, Systematic review",
author = "Charalampos Siotos and Konstantinos Stergios and Vishnu Prasath and Seal, {Stella M.} and Duncan, {Mark D.} and Joseph Sakran and Mehran Habibi",
year = "2019",
month = "3",
day = "1",
doi = "10.1016/j.jss.2018.10.005",
language = "English (US)",
volume = "235",
pages = "237--243",
journal = "Journal of Surgical Research",
issn = "0022-4804",
publisher = "Academic Press Inc.",

}

TY - JOUR

T1 - Irrigation Versus Suction in Laparoscopic Appendectomy for Complicated Appendicitis

T2 - Journal of Surgical Research

AU - Siotos, Charalampos

AU - Stergios, Konstantinos

AU - Prasath, Vishnu

AU - Seal, Stella M.

AU - Duncan, Mark D.

AU - Sakran, Joseph

AU - Habibi, Mehran

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Background: Acute appendicitis is currently one of the most common surgical emergencies. Intra-abdominal abscesses (IAA) are a fearsome complication, which may occur. Irrigation during the appendectomy is one of the factors suggested to affect the rates of IAA. We sought to investigate the evidence regarding the use of irrigation versus suction alone and the development of IAA after laparoscopic appendectomy for complicated appendicitis. Methods: We searched PubMed, Scopus, Embase, Cochrane, and the Web of Science through November 10, 2017, according to Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. We extracted information of interest, including rates of postoperative (IAA), and performed meta-analysis using random-effects model using the RevMan software. Results: We identified five eligible studies with 2511 patients in total. Use of irrigation overall did not demonstrate significant increase in IAA (odds ratio [OR] = 2.39, 95% confidence interval [CI; 0.49, 11.74], P = 0.28). For the adult subpopulation, the use of irrigation was associated with nonsignificant lower odds of IAAs (OR = 0.42, 95% CI [0.15, 1.16]), whereas in pediatric with nonsignificant higher risk (OR = 2.98, 95% CI [0.25, 35.34]). Performance of irrigation led to the addition of, on average, 7 min to the duration of the operation (mean difference = 7.16, 95% CI [3.23, 11.09], P < 0.001). Irrigation did not affect postoperative length of stay (mean difference = −0.80, 95% CI [−2.30, 0.69], P = 0.29). Conclusions: Performance of irrigation during laparoscopic appendectomy does not seem to prevent the development of IAA in neither adults nor pediatric patients.

AB - Background: Acute appendicitis is currently one of the most common surgical emergencies. Intra-abdominal abscesses (IAA) are a fearsome complication, which may occur. Irrigation during the appendectomy is one of the factors suggested to affect the rates of IAA. We sought to investigate the evidence regarding the use of irrigation versus suction alone and the development of IAA after laparoscopic appendectomy for complicated appendicitis. Methods: We searched PubMed, Scopus, Embase, Cochrane, and the Web of Science through November 10, 2017, according to Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. We extracted information of interest, including rates of postoperative (IAA), and performed meta-analysis using random-effects model using the RevMan software. Results: We identified five eligible studies with 2511 patients in total. Use of irrigation overall did not demonstrate significant increase in IAA (odds ratio [OR] = 2.39, 95% confidence interval [CI; 0.49, 11.74], P = 0.28). For the adult subpopulation, the use of irrigation was associated with nonsignificant lower odds of IAAs (OR = 0.42, 95% CI [0.15, 1.16]), whereas in pediatric with nonsignificant higher risk (OR = 2.98, 95% CI [0.25, 35.34]). Performance of irrigation led to the addition of, on average, 7 min to the duration of the operation (mean difference = 7.16, 95% CI [3.23, 11.09], P < 0.001). Irrigation did not affect postoperative length of stay (mean difference = −0.80, 95% CI [−2.30, 0.69], P = 0.29). Conclusions: Performance of irrigation during laparoscopic appendectomy does not seem to prevent the development of IAA in neither adults nor pediatric patients.

KW - Abscesses

KW - Appendectomy

KW - Irrigation

KW - Meta-analysis

KW - Systematic review

UR - http://www.scopus.com/inward/record.url?scp=85055752882&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85055752882&partnerID=8YFLogxK

U2 - 10.1016/j.jss.2018.10.005

DO - 10.1016/j.jss.2018.10.005

M3 - Review article

VL - 235

SP - 237

EP - 243

JO - Journal of Surgical Research

JF - Journal of Surgical Research

SN - 0022-4804

ER -