Primary Closure Versus Delayed Primary Closure in Perforated Appendix: A Comparative Study

Abstract

Introduction: The elimination of unpleasant and time-consuming dressing changes, as well as the potential reduction in overall hospital costs, are potential benefits of primary closure. Recent studies suggest that perforated appendicitis may usually be principally closed without an increase in the wound infection rate compared to delayed primary closure, suggesting that the disagreement surrounding the best ways of wound management has died down.

Objective: Studying the efficacy of primary versus delayed primary closure for appendectomy in patients with perforations

Study design: Ayyub Teaching Hospital Abbottabad and Timergara Teaching Hospital Dir Lower. Study duration from January 2021 to June 2021.

Material and Methods: Perforated appendix patients undergoing appendectomy between the ages of 18 and 45 were included. When an appendectomy was performed, the appendicular stump was not invaginated as is sometimes done nowadays. Interrupted 2/0 vicryl was used to stand in for muscles. Within the PC group, the external oblique was stitched shut with a continuous vicryl 0 suture. Using only regular saline, the wound washed and disinfected. For patients having delayed primary closure, dressing changes occurred daily; in the case of infection dressing changes occurred twice daily until the wound was closed. After the third postoperative day or once the infection had subsided in cases of infected wounds, the wound was closed after rejuvenating the edges. On the seventh postoperative day patients were evaluated for wound infection and length of hospital stay using the operational definition of success.

Results: The patients' mean age was 37.3± 610.49 years. The average number of days someone spent in the hospital was 7.38 (1.25). Women made up 37 (or 61.70%) of the total, while men accounted for 23 (or 38.30%). Thirteen patients, or 21.70 percent, had an infected wound. Wound infections occurred in 11 patients in Group-A (the primary closure group) but only 2 patients in Group-B (the delayed closure group) (delayed primary closure). When comparing the rate of wound infection in groups B and A, a statistically significant difference was discovered (p=0.005). Hospitalization time was shorter for those in group A (6.24± 0.47 days) compared to those in group B (8.53± 0.51 days); p 0.001.

Conclusion: Patients with a perforated appendix benefit more with primary closure than from delayed primary closure.

Keywords: Primary closure, delayed primary closure, and a perforated appendix