RANDOMIZED PROSPECTIVE-STUDY ON ANTIBIOTI C-PROPHYLAXIS COMPARED WITHLAVAGE OF THE SURGICAL-WOUND IN UNPERFORATED APPENDICITIS

BACKGROUND:: There are many doubts as to the efficacy of systemic anti biotic prophylaxis venus the methods of local treatment in the prevent ion of infection of the contaminated surgical wound. A controlled pros pective study was designed to compare the effectiveness of a combinati on of parenteral antibiotics with ravage with physiologic serum of the surgical wound to prevent Infection of the postappendectomy wound. ME THODS: The patients in group A (antibiotic, n = 70) received a sole pr eoperative dose of methronidazol and gentamicin while In those in grou p I (irrigation, n = 71) the wounds were irrigated with physiologic se rum prior to and following closure of aponeurosis. The patients were c ontrolled at one week and one month after the intervention. RESULTS: T he global rate of infection was 9.3%. Six patients of group A and five of group I developed wound Infection (p = 0.06), The age and length o f the intervention were significantly higher in the infected patients (41 vs 23 years, p = 0.0001 and 53 vs 41 minutes, p = 0.03, respective ly). Intraperitoneal culture was positive in 70% of the patients who p osteriorly developed wound infection, being positive in only 9.4% of t he unifected patients (p = 0.0001). Eight of the infections (73%) were detected following discharge from hospital. The cost of prophylaxis i n group A was seven-fold higher than that of group I. CONCLUSIONS: Lav age of the surgical wound with physiologic serum may be an effective, safe and inexpensive method to prevent Infection of the wound followin g appendicectomy for unperforated appendicitis.