WOUND INFECTION INCIDENCE WITH GANGRENOUS OR PERFORATED APPENDICITIS BETWEEN PRIMARY CLOSURE AND DELAYED PRIMARY CLOSURE

Background: Acute appendicitis is a common indication for emergency abdominal surgery. Surgical incisions after
appendicectomy for complicated (perforated/gangrenous) acute appendicitis are often managed with delayed primary
closure (DPC) rather than primary closure (PC). Delayed primary wound closure remains controversial.
Objective: To compare the difference in the rate of surgical wound infection, length of hospital stay and patients
convenience between primary closure and delayed primary closure after complicated (perforated/gangrenous) acute
appendicitis.
Materials and Methods: This comparative study was conducted at the Hayatabad Medical Complex, Peshawar from
Feb 2010 to Feb 2012, dealing with complicated appendicitis were reviewed to assess the results of Primary closure
(PC) in comparison with Delayed primary closure (DPC) of wound after complicated appendicitis. The rate of incision
(wound) infection, hospital stay and patient’s satisfaction, in groups of patients managed by PC and DPC were compared.
A total of 110 patients with complicated appendicitis were divided into two equal groups, (Group A) with 55
patients underwent primary closure and (Group B) with 55 patients underwent delayed primary closure.
Results: The mean age of the patients in Group A was 37.72±13.28 years and 35.3±14.1years in Group B patients
(p=0.3602). There were 38 (69%) males and 17 (31%) females in Group A, and 31 (56.3%) males and 24 (43.6%) females
in Group B (p=0.1187) (Table 1).Wounds infections were observed in 16 cases (14.5%), including 11 cases (20%) in
Group A and 5 cases (9.0%) in Group B (p=0.05235).Total length of hospital stay was (3.45±0.42) and (5.30±0.21) in
Group A and Group B respectively (p=0.0000001). Regarding patients satisfaction and pain score, patients convenience
was (68±36.59) and (36±81.43) in Group A and Group B respectively (p=0.009046).Three patients (5.4%)in Group A
and one patient (1.8%)in Group B had pelvic abscesses.
Conclusion: Primary wound closure in complicated appendicitis is convenient and satisfying for the patients, and also
reduces the overall cost of treatment with no added risk of surgical wound infection.
Keywords: Wound infection, primary closure (PC), delayed primary closure (DPC).