BACKGROUND: Appendectomy is the most frequent surgery done in most hospitals. Many modifications have been proposed in the technique in order to reduce complications and decrease discomfort from patients. The traditional interrupted non-absorbable closure is associated with a poor cosmesis and it requires stitch removal. In contrast with subcuticular absorbable closure technique which offers better cosmesis. This study is a single blinded randomized controlled trial with the objective of comparing the incidence of complications between the two closure technique.
METHODS: A prospective randomized controlled trial was used, a total of 200 post appendectomy patients were included and followed up for 30 days. They were randomized into two groups the first would have interrupted closure while the other will have a subcuticular closure. General characteristics like age, gender, BMI, Alvarado score, days of evolution, operative time, type of appendicitis were recorded. Outcomes measured includes the presence of superficial SSI, deep SSI, seroma, dehiscence, and abscess.
RESULTS: 5 patients were excluded for appendectomy due to resolution of symptoms during admission (negative appendicitis). While 8 patients were removed due to intraoperative findings of a generalized abscess and 9 patients were lost to follow up. 1 patients had an intraoperative finding of an ovarian cyst and was transferred to OB Gyne service A total of 177 patients were analyzed in this study, 88 patients for Interrupted group and 89 patients for Subcuticular group. General characteristics were compared, and no statistically significant differences were observed. The number of complicated appendicitis between the two groups were similar (18 vs 20 p=0.39). There was significant difference in the operative time (49.9 mins vs 47.7 mins, p=0.04). Complications were reported and compared. The interrupted group have a slightly higher total number of complications at 9.1% (8 patients) compared to subcuticular group which have 7.9% (7 patients). There were 3 patients who developed superficial SSSI, 1 patient with dehiscence, and 3 patients with abscess in the interrupted group. While in the subcuticular group there were 4 patients who developed superficial SSSI, 1 patient with deep SSSI, and 1 patient with abscess. Statistical analysis showed no significant difference in terms of incidence of superficial SSI, deep SSI, dehiscence and seroma ( p value 0.70, 0.31, 1 ,0.31 respectively). But showed a higher incidence of abscess in the interrupted group (3 vs 1, p=0.05).
CONCLUSION: Subcuticular absorbable closure is a safe technique with reduced abscess incidence and equivalent incidence of SSI, dehiscence, and seroma compared to interrupted closure.