Umbilical Negative Pressure Dressing for Transumbilical Appendectomy in Childern.
OBJECTIVE
Transumbilical laparoscopic-assisted appendectomy (TULAA) carries a high risk for surgical site infection. We investigated the effect of a bio-occlusive umbilical vacuum dressing on wound infection rates after TULAA for patients with acute appendicitis and compared to it with a conventional 3-port appendectomy with a nonvacuum dressing.


METHODS
This study was a retrospective chart review of 1377 patients (2-20 years) undergoing laparoscopic appendectomy for acute appendicitis in 2 tertiary care referral centers from January 2007 through December 2012. Twenty-two different operative technique/dressing variations were documented. The 6 technique/dressing groups with >50 patients were assessed, including a total of 1283 patients.


RESULTS
The surgical site infection rate of the 220 patients treated with TULAA and application of an umbilical vacuum dressing with dry gauze is 1.8% (95% CI, 0.0-10.3%). This compares to an infection rate of 4.1% (95% CI, 1.3-10.5%) in 97 patients with dry dressing without vacuum. In the 395 patients who received an umbilical vacuum dressing with gauze and bacitracin, the surgical site infection rate was found to be 4.3% (95% CI, 2.7-6.8%).


CONCLUSIONS
Application of an umbilical negative-pressure dressing with dry gauze lowers the rate of umbilical site infections in patients undergoing transumbilical laparoscopic-assisted appendectomy for acute appendicitis.
Department of Pediatric Surgery, Kalispell Regional Healthcare, Kalispell, Montana, USA.
Federico G
FG
Seifarth
Dermatology and Plastic Surgery Institute.
Neilendu
N
Kundu
Department of Surgery, Duke University, Durham, North Carolina, USA.
Alfredo D
AD
Guerron
Department of Internal Medicine, Wake Forest Baptist Hospital, Winston-Salem, North Carolina, USA.
Mary M
MM
Garland
Department of Internal Medicine, Wake Forest Baptist Hospital, Winston-Salem, North Carolina, USA.
Michaela W G
MW
Gaffley
Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Sarah
S
Worley
Department of Pediatric Surgery, Nicklaus Children's Hospital, Miami, Florida, USA.
Colin G
CG
Knight
D000208:Acute Disease; D000293:Adolescent; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D001458:Bandages; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D012189:Retrospective Studies; D013530:Surgical Wound Infection; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D014472:Umbilicus; D055815:Young Adult
Appendectomy; Appendicitis; TULAA; Vacuum dressing; Wound Infection