Gangrenous and perforated appendicitis: A meta-analytic study of 2532 patients indicates that the incision should be closed primarily

Background. Surgical incisions after appendectomy for complicated (gangreno us or perforated) acute apppendicitis are often managed with delayed closur e (DC) rather than primary closure (PC). This study synthesizes the results of other studies in the surgical literature and supports the routine use o f PC. Methods. Studies dealing with complicated appendictis were reviewed to asse ss the results of PC in comparison with DC. The rate of incision (wound) in fection in groups of patients managed by PC and DC were compared with the u se of a statistical technique that defined the probability of expected resu lts by incorporating data derived from all of the various study groups. Results. Of the 2532 patients who had been treated for complicated appendic itis and who were assessed, 1724 patients underwent PC and 808 patients und erwent DC. The rate of incision infection was 4.7% and 4.6% in the PC and D C groups, respectively. With a 95 % confidence interval, there was no demon strable difference between the 2 types of operative site management (P <. 0 1). Conclusions. PC of the skin and subcutaneous tissue after appendectomy for gangrenous or perforated appendictis, combined with the use of antibiotic t herapy in the perioperative period, is not associated with an increased ris k of incision infection when compared with DC.