Patients
All patients treated in our hospital for acute appendicitis between January 2011 and
August 2013 enrolled the study cohort. Patients with uncomplicated appendicitis and
patients with a malignancy (after pathological examination) were excluded (n = 1,029).
A total of 199 patients diagnosed with perforated appendicitis were included for further
analysis.
Diagnosis
All patients were pre-operatively examined by the surgeon on call. The diagnosis of
appendicitis was made by the attending surgeon according to the guidelines of the
Association of Surgeons of the Netherlands (Heelkunde 2010]). If necessary, additional ultrasonography or multislice computed tomography (CT,
Siemens Definition scanner, Siemens, Munich, Germany) was performed to confirm diagnosis
of acute appendicitis. Diagnosis of perforated appendicitis was made intra-operatively.
Treatment
All patients received preoperative antimicrobial prophylaxis consisting of intravenous
Cefazoline and Metronidazole however, in patients with a known allergic reaction of
one of these antibiotics a combination of Clindamycin and Tobramycin was prescribed.
General anesthesia was performed in all patients. The operating surgeon decided whether
laparoscopic or open appendectomy was performed, based on surgeon specific experience
and preferences. Peritoneal lavage with warmed with isotonic saline was performed
after appendectomy.
Leaving an intra-peritoneal drain (Silicone- or Redon drain) after appendectomy was
decided by the performing surgeon based on the observed operative contamination and
expertise.
In all patients, the abdominal fascia was closed, in some selected cases the dermis
was approximated or left open. Postoperatively intravenous antibiotics were prescribed
in all included patients for at least 3Â days following our hospital protocols. Drains
were removed after at least 24Â h based on the production and aspect of the drained
fluid.
Outcome
Patients were classified into two groups. The first group consisted of patients diagnosed
with perforated appendicitis treated with peritoneal drainage. The second group consisted
of patients diagnosed with perforated appendicitis treated without peritoneal drainage.
Complications were identified and categorized in the following groups: overall complications,
re-interventions, duration of hospital stay and readmissions. The duration of a readmission
was included in the hospital stay calculation. Overall complications were defined
as wound infection, intra-abdominal abscess formation, post-operative abdominal pain
and stump leakage. Post-operative abdominal pain was defined as abdominal complains
after surgery requiring prolonged clinical observation or additional biochemistry
or radiological tests.
Re-interventions were defined as percutaneous drainage, re-laparoscopy/laparotomy,
transrectal drainage and prolonged use of intravenous antibiotics (3–5 days).
Statistical analysis
Statistical analyses were performed using SPSS, version 21.0 (SPSS, Inc., Chicago,
USA). Chi-square analysis was performed to evaluate proportional differences between
the two groups. Mann–Whitney U test was performed for continues data. P values of
?0.05 were considered significant.
Ethics approval
Ethical approval for this study was provided by the local ethical committee of the
Amphia Hospital.