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Andrade LAM, Muñoz FYP, Báez MVJ, Collazos SS, de Los Angeles Martinez Ferretiz M, Ruiz B, Montes O, Woolf S, Noriega JG, Aparicio UM, Gonzalez IG. Appendectomy Skin Closure Technique, Randomized Controlled Trial: Changing Paradigms (ASC). World J Surg 2017; 40:2603-2610. [PMID: 27283187 DOI: 10.1007/s00268-016-3607-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Appendectomy is the most frequent and urgent gastrointestinal surgery. Overtime, the surgical techniques have been improved upon, in order to reduce complications, get better cosmetic results, and limit the discomfort associated with this procedure, by its high impact in the surgery departments. The traditional skin closure is associated with a poor cosmetic result and it requires stitches removal, alongside the pain associated with this procedure, and no benefits were demonstrated in the literature regarding separated stitches over intradermic stitch. This is a randomized controlled trial, and our objective is to compare two different skin closure techniques in open appendectomy. METHODS A prospective randomized trial method was used, with a total number of 208 patients participating in the study, after acute appendicitis diagnosis in the emergency department. They were randomized into two groups: patients who would receive skin closure with a unique absorbable intradermic stitch (Group A) and another group that would receive the traditional closure technique, consistent in non-absorbable separated stitches (Group B). General characteristics like gender, age, Body Mass Index (BMI), comorbidities, and allergies were registered. Days of Evolution (DOE) until surgery, previous use of antibiotics, complicated or uncomplicated appendicitis, surgical time, and wound complications like skin infection, dehiscence, seroma or abscess were also registered in each case. RESULTS 8 patients were excluded due to negative appendicitis during surgery and lack of follow-up. Two groups, each containing 100 patients, were formed. General characteristics and parity were compared, and no statistically significant differences were observed. Difference in the surgical time (Group A: 47.35 min vs Group B: 54.13 min, p < .001) and cases with complicated appendicitis (Group A: 58 and Group B:38, p = .005) were found to be statistically significant. Four wound complications were reported, and the incidence of seroma (Group A:0 and Group B:5, p = .02) and abscess (Group A:2 and Group B:8, p = .05) were found to have some statistical significant difference. In a multivariate analysis, a relationship was observed between BMI > 25 kg/m2 and seroma (p = .006), BMI > 25 kg/m2 and abscess (p = .02), surgical time >50 min and seroma (p < .001), >2 DOE and abscess (p = .001), and complicated appendicitis with seroma development (p = .03). CONCLUSION Open appendectomy skin closure with a unique absorbable intradermic stitch is safe, with a reduced seroma and abscess incidence, compared to traditional closure, and an equivalent dehiscence and superficial infection incidence, allowing a lower hospital attention cost and length of hospital stay for treatment of complications. The relative risk of complications with traditional skin closure is 2.91 higher, compared to this new technique.
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Affiliation(s)
- Luis Angel Medina Andrade
- Instituto Mexicano del Seguro Social, Hospital General Regional No. 17, General Surgery Department, Quintana Roo University, Av. Politécnico Manzana 1 Lote 1 Región 509, C.P. 55750, Cancún, Quintana Roo, Mexico.
| | - Franz Yeudiel Pérez Muñoz
- Instituto Mexicano del Seguro Social, Hospital General Regional No. 17, General Surgery Department, Quintana Roo University, Av. Politécnico Manzana 1 Lote 1 Región 509, C.P. 55750, Cancún, Quintana Roo, Mexico
| | - María Valeria Jiménez Báez
- Health Research Department, Quintana Roo, Instituto Mexicano del Seguro Social, Av. Politécnico Manzana 1 Lote 1 Región 509, C.P. 55750, Cancún, Quintana Roo, Mexico
| | - Stephanie Serrano Collazos
- Instituto Mexicano del Seguro Social, Hospital General Regional No. 17, General Surgery Department, Quintana Roo University, Av. Politécnico Manzana 1 Lote 1 Región 509, C.P. 55750, Cancún, Quintana Roo, Mexico
| | - Maria de Los Angeles Martinez Ferretiz
- Instituto Mexicano del Seguro Social, Hospital General Regional No. 17, General Surgery Department, Quintana Roo University, Av. Politécnico Manzana 1 Lote 1 Región 509, C.P. 55750, Cancún, Quintana Roo, Mexico
| | - Brenda Ruiz
- Instituto Mexicano del Seguro Social, Hospital General Regional No. 17, General Surgery Department, Quintana Roo University, Av. Politécnico Manzana 1 Lote 1 Región 509, C.P. 55750, Cancún, Quintana Roo, Mexico
| | - Oscar Montes
- Instituto Mexicano del Seguro Social, Hospital General Regional No. 17, General Surgery Department, Quintana Roo University, Av. Politécnico Manzana 1 Lote 1 Región 509, C.P. 55750, Cancún, Quintana Roo, Mexico
| | - Stephanie Woolf
- Instituto Mexicano del Seguro Social, Hospital General Regional No. 17, General Surgery Department, Quintana Roo University, Av. Politécnico Manzana 1 Lote 1 Región 509, C.P. 55750, Cancún, Quintana Roo, Mexico
| | - Jessica Gonzalez Noriega
- Hospital General de Zona #1. Instituto Mexicano del Seguro Social, Universidad Nacional Autónoma de México, 5 de Febrero, Col. Pueblo Nuevo, La Paz, Baja California Sur, Mexico
| | - Uriel Maldonado Aparicio
- Hospital General de Zona #1. Instituto Mexicano del Seguro Social, Universidad Nacional Autónoma de México, 5 de Febrero, Col. Pueblo Nuevo, La Paz, Baja California Sur, Mexico
| | - Israel Gonzalez Gonzalez
- General Surgery Department, The American British Cowdray Medical Center I.A.P, Universidad Nacional Autonoma de Mexico, Sur 136 #116, Col. Las Americas, Alvaro Obregon, C.P. 01120, Distrito Federal, Mexico
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