Appendicitis Irrigation Technique with ZERO Abscesses!

This is Todd Ponsky with the Journal of Pediatric Surgery and here's your video review. Today we have Maria Libertin with us again. She's a second year medical student at the Northeast Ohio Medical University. And today she's going to review a paper that caught our eye out of the Journal of Pediatric Surgery. This was a paper that went over irrigation with perforated appendicitis. Now, this is a topic that's been done before. There was a study out of Kansas City that showed that there was no difference in if you irrigate or don't irrigate. However, this study was interesting because at University of Minnesota, there was one surgeon who had a very interesting and time-consuming method to irrigate in perforated appendicitis. His partners thought it was crazy. So they decided to do a review to show him that this was overkill. However, the results may surprise you. Maria. Thanks. So this study was called Standardized Irrigation Technique Reduces Intra-abdominal Abscess After Appendectomy. It was published by Leplant and Salsman and was published in the August 2018 issue of Journal of Pediatric Surgery. As Todd said, it was done at the University of Minnesota and it was from one surgeon who developed a technique for laparoscopic appendectomy. He used peritoneal irrigation for serial dilution with multiple low aliquots and debridement of fibrous material. The hypothesis of the study was that there was no difference in the infection rates between this surgeon's technique and the normal technique with minimal dilution. For perforation, they could use up to 6 liters of normal saline, and for extensive peritonitis with or without interloop abscess, they could use from 9 to 12 liters. The primary outcome measured was intra-abdominal abscess formation after appendectomy. The results showed that after irrigation for serial dilution, no patients developed an intra-abdominal abscess out of 140 patients. However, 18 out of the 292 patients developed intra-abdominal abscess after discretionary irrigation. There were drawbacks as well with this technique including the tediousness and the time added to the operation. The main takeaway from this study is that previous studies have told us that irrigation has no difference in the outcome. And here we have a study that's reopening that discussion for us to look further into. Thanks Maria. So, I just got to get this right because it sounds crazy to me. So, this surgeon uses 50 cc aliquots and he uses a total of 6 liters. So that's 120 times that he does this at the end of the case. Is that right? Yeah. That seems nuts. It is to the sense that they did talk about the tediousness of it, but he had zero infections. Like zero intra-abdominal abscesses. So, zero infections. So, how much time is it worth in the operating room to spend to get zero infections? This surgeon clearly showed that by doing 120 times of 50 cc aliquots, he was able to get zero infections in 140 patients. And the group that didn't do this had about a 6% post-operative abscess rate. So there you go. You make your decision. It sounds like this works, very controversial. I'm curious what people say. Thanks a lot for the review and we'll wait for your comments below. Thanks.