Comparison of Superficial Surgical Site Infection between Delayed Primary versus Primary Wound Closure in Complicated Appendicitis

Abstract Background: Acute appendicitis is the most common cause of acute abdomen in adults. Open appendicectomy is the treatment of choice for complicated appendicitis. Perforated appendicitis has an infection rate 15-20% post-operative surgical site infection can increase morbidity. Thus it can lead to increase in post-operative pain, hospital stay, sepsis and patient dissatisfaction, Surgical Site Infection (SSI) and its associated complications like wound dehiscence, stitch sinuses, incisional hernias, hypertrophic scar and keloid formation are not only a source of discomfort for the patients but also discouraging for the surgeons. These complications prolong the post-operative stay of patient and increase the cost of treatment. Aim of Study: To compare the efficacy of primary wound closure with delayed primary wound closure in terms of wound infection after surgery for perforated appendix and get local evidence of the effectiveness of either procedure. Patients and Methods: This study was done between May 2018 and December 2018 in the General Surgery Department in Ain Shams University Hospital and Damietta General Hospital. The study included 50 patients presented with complicated appendicitis. The patients were divided into 2 groups A and B using lottery method. Patient in group-A underwent primary closure of the skin immediately after surgery while patients in group-B were subjected to delayed primary closure of the skin for perforated appendix. Results: In our study, in delayed primary closure there was 2 patients with positive signs of superficial surgical wound infection but in primary closure there was 11 patients. The total post-operative hospital stay in delayed primary closure ranges from 4 to 9 days and in primary closure ranges from 3 to 9 days with no significant difference between the two groups. Conclusion: Our study suggested that patients undergoing open appendectomy for complicated appendicitis, DPC was the preferable method for wound management than primary closure because of a lower incidence of wound infection DPC could be considered for wound management in patients with perforated appendicitis.