Background: Appendectomy is one of the most common abdominal operations. The prevalence of appendicitis increases with increased lymphatic tissue with the maximum prevalence at the beginning of adulthood. Owing to the high prevalence of appendectomy, patients will be benefited from a better method with improvement of surgical site and management of postoperative pain and infection. Subcuticular repair method due to better scar formation and less pain is preferred to the routine repair method, if the infection rate is comparable.
Methods: The current study was conducted on appendectomy candidates in 2017. After providing the necessary explanations, the interested patients signed the informed consent forms and voluntarily participated in the study. The subjects were randomly assigned into two groups of randomized clinical trial with parallel design and 1:1 ratio. The sample size was 120 individuals based on previous studies. Subjects were assigned into two groups of 105 subjects each: the first group as subcuticular and the second group as transdermal accordingly. Then, they were studied and followed up.
Results: One week after operation, 8.5% of subcuticular and 5.7% of transdermal repairs developed localized infection, and no significant difference was observed between the two groups. One week after surgery in the first group, 10% had no pain, 36% mild pain, 27% moderate pain, and 27% severe pain. In the second group, 7% had no pain, 36% mild pain, 30% moderate pain, and 27% severe pain. Therefore, there was no significant difference between two groups in this regard.
Conclusion: There was no significant difference in the surgical wound infection rate between two methods. Accordingly, subcuticular repair was suggested as the preferred method owing to its better scar formation.
Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston textbook of surgery. Amsterdam: Elsevier Health Sciences; 2016.
Kotaluoto S, Pauniaho SL, Helminen M, Kuokkanen H, Rantanen T. Wound healing after open appendectomies in adult patients: A prospective, randomised trial comparing two methods of wound closure. World Journal of Surgery. 2012; 36(10):2305-10. [DOI:10.1007/s00268-012-1664-3] [PMID]
Kumar V, Abbas AK, Aster JC. Robbins basic pathology e-book. Amsterdam: Elsevier Health Sciences; 2017.
Kellum JM. Maingot’s abdominal operations. Annals of Surgery. 2008; 248(5):893-4. [DOI:10.1097/SLA.0b013e31818b7417]
Flum DR, McClure TD, Morris A, Koepsell T. Misdiagnosis of appendicitis and the use of diagnostic imaging. Journal of the American College of Surgeons. 2005; 201(6):933-9. [DOI:10.1016/j.jamcollsurg.2005.04.039] [PMID]
Brunicardi F, Andersen D, Billiar T, Dunn D, Hunter J, Matthews J, et al. Schwartz’s principles of surgery. New York: McGraw-Hill Education; 2014. [PMCID]
Kosloske AM, Love CL, Rohrer JE, Goldthorn JF, Lacey SR. The diagnosis of appendicitis in children: Outcomes of a strategy based on pediatric surgical evaluation. Pediatrics. 2004; 113(1):29-34. [PMID]
Ditillo MF, Dziura JD, Rabinovici R. Is it safe to delay appendectomy in adults with acute appendicitis? Annals of Surgery. 2006; 244(5):656-60. [DOI:10.1097/01.sla.0000231726.53487.dd] [PMID] [PMCID]
Eldar S, Nash E, Sabo E, Matter I, Kunin J, Mogilner JG, et al. Delay of surgery in acute appendicitis. The American Journal of Surgery. 1997; 173(3):194-8. [DOI:10.1016/S0002-9610(96)00011-6]
Onwuanyi O, Evbuomwan I. Skin closure during appendicectomy: A controlled clinical trial of subcuticular and interrupted transdermal suture techniques. Journal of the Royal College of Surgeons of Edinburgh. 1990; 35(6):353-5. [PMID]
Pauniaho SL, Lahdes Vasama T, Helminen M, Iber T, Mäkelä E, Pajulo O. Non-absorbable interrupted versus absorbable continuous skin closure in pediatric appendectomies. Scandinavian Journal of Surgery. 2010; 99(3):142-6. [DOI:10.1177/145749691009900308] [PMID]
Foster G, Hardy E, Hardcastle J. Subcuticular suturing after appendicectomy. The Lancet. 1977; 309(8022):1128-9. [DOI:10.1016/S0140-6736(77)92385-6]
Gurusamy KS, Toon CD, Allen VB, Davidson BR. Continuous versus interrupted skin sutures for non-obstetric surgery. 2014; 14(2):CD010365. [DOI: 10.1002/14651858.CD010365.pub2] [PMID]
Serour F, Efrati Y, Klin B, Barr J, Gorenstein A, Vinograd I. Subcuticular skin closure as a standard approach to emergency appendectomy in children: Prospective clinical trial. World Journal of Surgery. 1996; 20(1):38-42. [DOI:10.1007/s002689900007] [PMID]
Vipond M, Higgins A. Subcuticular prolene or PDS for skin closure. Journal of the Royal College of Surgeons of Edinburgh. 1991; 36(2):97-9. [PMID]
Mehta PH, Dunn KA, Bradfield JF, Austin PE. Contaminated wounds: Infection rates with subcutaneous sutures. Annals of Emergency Medicine. 1996; 27(1):43-8. [DOI:10.1016/S0196-0644(96)70295-0]