title: Irrigation versus suction alone during laparoscopic appendectomy for perforated appendicitis: a prospective randomized trial.
abstract: BACKGROUND
  The efficacy of irrigating the peritoneal cavity during appendectomy for perforated appendicitis has been debated extensively. To date, prospective comparative data are lacking. Therefore, we conducted a prospective, randomized trial comparing peritoneal irrigation to suction alone during laparoscopic appendectomy in children.
  
  
  METHODS
  Children younger than 18 years with perforated appendicitis were randomized to peritoneal irrigation with a minimum of 500 mL normal saline, or suction only during laparoscopic appendectomy. Perforation was defined as a hole in the appendix or fecalith in the abdomen. The primary outcome variable was postoperative abscess. Using a power of 0.8 and alpha of 0.05, a sample size of 220 patients was calculated. A battery-powered laparoscopic suction/irrigator was used in all cases. Pre- and postoperative management was controlled. Data were analyzed on an intention-to-treat basis.
  
  
  RESULTS
  A total of 220 patients were enrolled between December 2008 and July 2011. There were no differences in patient characteristics at presentation. There was no difference in abscess rate, which was 19.1% with suction only and 18.3% with irrigation (P = 1.0). Duration of hospitalization was 5.5 ± 3.0 with suction only and 5.4 ± 2.7 days with group (P = 0.93). Mean hospital charges was $48.1K in both groups (P = 0.97). Mean operative time was 38.7 ± 14.9 minutes with suction only and 42.8 ± 16.7 minutes with irrigation (P = 0.056). Irrigation was felt to be necessary in one case (0.9%) randomized to suction only. In the patients who developed an abscess, there was no difference in duration of hospitalization, days of intravenous antibiotics, duration of home health care, or abscess-related charges.
  
  
  CONCLUSIONS
  There is no advantage to irrigation of the peritoneal cavity over suction alone during laparoscopic appendectomy for perforated appendicitis. The study was registered with clinicaltrials.gov at the inception of enrollment (NCT00981136).
authors.affiliation: Center for Prospective Clinical Trials, Department of Surgery, The Children's Mercy Hospital, Kansas City, MO 64108, USA. sspeter@cmh.edu
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
authors.forename: Obinna O
authors.initials: OO
authors.lastname: Adibe
authors.forename: Corey W
authors.initials: CW
authors.lastname: Iqbal
authors.forename: Frankie B
authors.initials: FB
authors.lastname: Fike
authors.forename: Susan W
authors.initials: SW
authors.lastname: Sharp
authors.forename: David
authors.initials: D
authors.lastname: Juang
authors.forename: David
authors.initials: D
authors.lastname: Lanning
authors.forename: J Patrick
authors.initials: JP
authors.lastname: Murphy
authors.forename: Walter S
authors.initials: WS
authors.lastname: Andrews
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Sharp
authors.forename: Charles L
authors.initials: CL
authors.lastname: Snyder
authors.forename: George W
authors.initials: GW
authors.lastname: Holcomb
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Ostlie
mesh_terms: D018784:Abdominal Abscess / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D000293:Adolescent; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057194:Intention to Treat Analysis; D010535:Laparoscopy; D008297:Male; D010533:Peritoneal Lavage; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011446:Prospective Studies; D013396:Suction; D016896:Treatment Outcome