[A randomized prospective study of antibiotic prophylaxis compared to lavage of the surgical wound in nonperforating appendicitis].

BACKGROUND

There are many doubts as to the efficacy of systemic antibiotic prophylaxis versus the methods of local treatment in the prevention of infection of the contaminated surgical wound. A controlled prospective study was designed to compare the effectiveness of a combination of parenteral antibiotics with lavage with physiologic serum of the surgical wound to prevent infection of the postappendectomy wound.

METHODS

The patients in group A (antibiotic, n = 70) received a sole preoperative dose of methronidazol and gentamicin while in those in group I (irrigation, n = 71) the wounds were irrigated with physiologic serum prior to and following closure of aponeurosis. The patients were controlled at one week and one month after the intervention.

RESULTS

The global rate of infection was 9.3%. Six patients of group A and five of group I developed wound infection (p = 0.06), The age and length of the intervention were significantly higher in the infected patients (41 vs 23 years, p = 0.0001 and 53 vs 41 minutes, p = 0.03, respectively). Intraperitoneal culture was positive in 70% of the patients who posteriorly developed wound infection, being positive in only 9.4% of the uninfected patients (p = 0.0001). Eight of the infections (73%) were detected following discharge from hospital. The cost of prophylaxis in group A was seven-fold higher than that of group I.

CONCLUSIONS

Lavage of the surgical wound with physiologic serum may be an effective, safe and inexpensive method to prevent infection of the wound following appendicectomy for unperforated appendicitis.