LETTER TO THE EDITOR Irrigation Versus Suction Alone During Laparoscopic Appendectomy for Perforated Appendicitis: A Prospective Randomized Trial To the Editor: his interesting article by St Peter et al1 highlights some important messages. The study concludes that the incidence of postoperative abscess formation is common regardless of the intraoperative strategy employed to reduce the contamination. However, an important concern in these children is the formation of postoperative
T
adhesions. The pathogenesis is related to the peritoneal damage inflicted by insults such as the presence of contaminated exudates.2 In this study, it is unclear whether the volume of exudate is initially aspirated. The subsequent inflammatory response results in fibrin and adhesion formation.2 In addition to small bowel obstruction, there is an association between adhesions and infertility.3 It should be realized that this study was not powered to investigate these complications. That said, in the suction-only group, the incidence of postoperative small bowel obstruction was 3 times higher than that in the irrigation group. This was not a significant finding; however, it is a worrying trend. In addition, in the irrigation group, there was a trend of developing remote left upper quadrant collections. During laparoscopic appendectomy, a pragmatic approach should be adopted.
Focused irrigation should be reserved for situations when significant contamination is present. Otherwise, a suction-only approach should be used. Ravinder S. Vohra, MD, PhD Academic Department of Surgery University of Birmingham Birmingham, United Kingdom [email protected]
REFERENCES 1. St. Peter SD, Adibe OO, Iqbal CW, et al. Irrigation versus suction alone during laparoscopic appendectomy for perforated appendicitis: a prospective randomized trial. Ann Surg. 2012;256:581–585. 2. Hellebrekers BW, Kooistra T. Pathogenesis of postoperative adhesion formation. Brit J Surg. 2011;98:1503–1516. 3. Diamond MP, Freeman ML. Clinical implications of postsurgical adhesions. Hum Reprod Update. 2001;7:567–576.
Disclosure: The author declares no conflicts of interest. C 2014 Wolters Kluwer Health, Inc. All Copyright rights reserved. ISSN: 0003-4932/14/26104-e0111 DOI: 10.1097/SLA.0000000000000488
Annals of Surgery r Volume 261, Number 4, April 2015
www.annalsofsurgery.com | e111
Copyright © 2014 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
T
adhesions. The pathogenesis is related to the peritoneal damage inflicted by insults such as the presence of contaminated exudates.2 In this study, it is unclear whether the volume of exudate is initially aspirated. The subsequent inflammatory response results in fibrin and adhesion formation.2 In addition to small bowel obstruction, there is an association between adhesions and infertility.3 It should be realized that this study was not powered to investigate these complications. That said, in the suction-only group, the incidence of postoperative small bowel obstruction was 3 times higher than that in the irrigation group. This was not a significant finding; however, it is a worrying trend. In addition, in the irrigation group, there was a trend of developing remote left upper quadrant collections. During laparoscopic appendectomy, a pragmatic approach should be adopted.
Focused irrigation should be reserved for situations when significant contamination is present. Otherwise, a suction-only approach should be used. Ravinder S. Vohra, MD, PhD Academic Department of Surgery University of Birmingham Birmingham, United Kingdom [email protected]
REFERENCES 1. St. Peter SD, Adibe OO, Iqbal CW, et al. Irrigation versus suction alone during laparoscopic appendectomy for perforated appendicitis: a prospective randomized trial. Ann Surg. 2012;256:581–585. 2. Hellebrekers BW, Kooistra T. Pathogenesis of postoperative adhesion formation. Brit J Surg. 2011;98:1503–1516. 3. Diamond MP, Freeman ML. Clinical implications of postsurgical adhesions. Hum Reprod Update. 2001;7:567–576.
Disclosure: The author declares no conflicts of interest. C 2014 Wolters Kluwer Health, Inc. All Copyright rights reserved. ISSN: 0003-4932/14/26104-e0111 DOI: 10.1097/SLA.0000000000000488
Annals of Surgery r Volume 261, Number 4, April 2015
www.annalsofsurgery.com | e111
Copyright © 2014 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
