Escolino Maria, Becmeur Francois, Saxena Amulya, Till Holger, Masieri Lorenzo, Cortese Giuseppe, Holcomb George W, Esposito Ciro
1 Division of Pediatric Surgery, Federico II University of Naples , Naples, Italy .
2 Division of Pediatric Surgery, Hopitaux Universitaires de Strasbourg , Strasbourg, France .
J Laparoendosc Adv Surg Tech A. 2018 Oct;28(10):1266-1270. doi: 10.1089/lap.2018.0061. Epub 2018 Jun 15.
Analyzing the recent literature, it seems that the use of irrigation increases the incidence of intra-abdominal abscesses (IAAs) and infectious complications in perforated appendicitis. The aim of this study was to compare peritoneal irrigation and suction versus suction only during laparoscopic appendectomy (LA) for perforated appendicitis in children.
We retrospectively reviewed the records of 699 patients (460 boys and 239 girls, average age 9.8 years) who underwent LA for complicated appendicitis in six international centers of pediatric surgery over a 5-year period. The appendix was perforated with localized peritonitis in 465 cases and diffuse peritonitis in 234 patients. Irrigation + suction was used in 488 cases (group 1 [G1]), whereas suction only was used in 211 cases (group 2 [G2]).
No significant difference between the two groups was found in regard to average operative time (P = .23), average time of resumption of oral diet (P = .55), average reprise of gastrointestinal transit (P = .55), and average length of hospital stay (P = .41). As for postoperative complications, the incidence of IAAs was significantly higher in G2 (41/211; 19.4%) compared with G1 (38/488; 7.7%) (P = .0000), whereas no significant difference was found between the two groups in regard to wound infection (G1: n = 2 or 0.4%; G2: n = 4 or 1.8%; P = .05) and small bowel obstruction rates (G1: n = 8 or 1.6%; G2: n = 2 or 0.9%; P = .47).
In contrast with the most recent literature on this topic, our results demonstrated that peritoneal irrigation and suction were associated with a lower rate of postoperative IAA formation compared with the suction-only approach in children with perforated appendicitis. In such cases, peritoneal irrigation and abdominal drainage should be the preferred methods for peritoneal toilette, with no increase in operative time and postoperative morbidity.
分析近期文献发现，在穿孔性阑尾炎中使用冲洗似乎会增加腹腔内脓肿（IAA）的发生率和感染性并发症。本研究的目的是比较儿童穿孔性阑尾炎腹腔镜阑尾切除术（LA）中腹膜冲洗吸引与单纯吸引的效果。
我们回顾性分析了6个国际小儿外科中心5年间699例行LA治疗复杂性阑尾炎患者（460例男孩和239例女孩，平均年龄9.8岁）的记录。465例阑尾穿孔伴局限性腹膜炎，234例伴弥漫性腹膜炎。488例采用冲洗+吸引（第1组[G1]），211例仅采用吸引（第2组[G2]）。
两组在平均手术时间（P = 0.23）、平均恢复经口饮食时间（P = 0.55）、平均胃肠功能恢复时间（P = 0.55）和平均住院时间（P = 0.41）方面无显著差异。至于术后并发症，G2组（41/211；19.4%）的IAA发生率显著高于G1组（38/488；7.7%）（P = 0.0000），而两组在伤口感染（G1：n = 2或0.4%；G2：n = 4或1.8%；P = 0.05）和小肠梗阻发生率（G1：n = 8或1.6%；G2：n = 2或0.9%；P = 0.47）方面无显著差异。
与该主题的最新文献相反，我们的结果表明，在穿孔性阑尾炎患儿中，与单纯吸引方法相比，腹膜冲洗吸引术后IAA形成率较低。在这种情况下，腹膜冲洗和腹腔引流应是腹膜清洁的首选方法，且不增加手术时间和术后发病率。
