LAPAROSCOPIC LAVAGE VERSUS SUCTION ONLY IN COMPLICATED ACUTE APPENDICITIS: A PROSPECTIVE RANDOMISED CONTROL STUDY.

BACKGROUND: The role of laparoscopy in complicated appendicitis is increasing. It is unclear in the adult population whether lavage of the pus versus suction only impacts in decreasing postoperative collections. In children there appears to be no difference whether the pus is lavaged or suctioned only. This study will be the first of its kind in the adult population.

METHOD: A prospective single blinded randomised control trial was conducted. Ethics clearance was obtained from the review board. Registered on research registry UIN 1718. Patients with suspected acute appendicitis were consented to be enrolled in the study. Those found to have complicated appendicitis (perforation, localised pus or four quadrant pus) at laparoscopy were randomised according to computer generated allotment to either lavage or suction only. Patients who did not have the appendix removed or who were converted to laparotomy were excluded. Lavage consisted of a strict protocol of three litres of lavage with normal saline. Operative time was documented. All patients had an 8 mm pencil drain placed. Postoperatively a minimum of five days of intravenous Coamoxiclav. Complications (relook, percutaneous drain), hospital stay and return of bowel function were recorded.

RESULTS: A total of 43 patients were assessed of which 10 were excluded - seven were converted to laparotomies. Also, three had abscesses but appendix was not removed. The remaining 33 patients were analysed. The mean age was 26 years (14-74). Fifteen (45%) patients were lavaged and 18 (55%) were suctioned. Four quadrant pus was present inc4 (26%) of the lavage group versus in 6 (33%) of suctioncgroup. Complications developed in seven patients (46.7%)cwho were lavaged compared to five patients (27.8%) whocreceived suction only. The absolute risk increase is 20% withclavage giving a number needed to harm of 5. The differencecdid not reach significance due to sample size (p = 0.301).cOperative time was longer in the lavage group by 30 minutesc(p = 0.086). If a complication developed then the hospitalcstay was significantly prolonged 13.5 days versus 5 daysc(p < 0,001). The study was stopped by the ethics review boardcdue to the higher rate of complications in the lavage group.

CONCLUSION: This pilot study of lavage versus suction only in complicated appendicitis revealed a higher rate of complications in those randomised to lavage. There was also a trend toward longer operating time in those who were lavaged. If a patient develops a complication, then the hospital stay was significantly prolonged.