Appendicectomy Skin Closure Technique: Changing Paradigms (ASC)
Appendicectomy Skin Closure Technique: Changing Paradigms (ASC)
To compare the results associated with two different skin closure techniques in open
 appendectomy. 200 patients were included after acute appendicitis diagnosis in emergency
 department. They were grouped randomly into two groups: patients who would receive skin
 closure with skin closure by an unique absorbable intradermic stitch (Group A) and another
 that would receive a habitual technique consistent in non absorbable separated stitches
 (Group B). General characteristics like gender, age, body mass index (IMC), comorbidities and
 allergies were registered. Days of evolution (DOE) until surgery, use of antibiotics
 previously, complicated or uncomplicated appendicitis, surgery time and wound complications
 like skin infection, dehiscence, seroma or abscess were registered in each case too,
Registration number R2015-2301-6 by Local Committee on Ethics in Health Research and Social
 Security Mexican Institute, Zone 03 General Hospital. The investigators conduct the study at
 the Hospital General Regional No. 17 in Cancun, Quintana Roo. México. At time in which
 General Surgery Department determined acute appendicitis diagnosis and prophylaxis
 antibiotics administered with 3rd generation cephalosporin and Metronidazole, patients
 receive information about the study and treatment options and informed consent were signed.
 After this, patients were randomly assigned to one of two study groups. Group A receives a
 skin closure with a unique absorbable suture intradermal stitch. Group B receives a skin
 closure with habitual technique, consistent in separated stitch of a non-absorbable suture.
 The surgical and skin closure techniques were standardized among eight surgeons who
 participate in the study.

 Acute appendicitis diagnosis was established by clinical history, physical exam and
 laboratory test including blood count, glucose, urea, creatinine, general urinary exam and
 clothing times. An Alvarado scale >7 points or the surgeon opinion was diagnostic of
 appendicitis. General information about the patients were recorded like gender, age, body
 mass index (IMC), comorbidities and allergies were registered. Clinical history information
 like DOE and previous antibiotics use were registered too.

 After explanation of the diagnosis and treatment options, the patients were informed about
 this study, the objectives, implications, possible outcomes and complications. The patients
 or legal tutor of the patients refer to understand the possible risk and consequences and if
 they accept to be included in the study an informed consent was signed.

 One hour before skin incision a prophylaxis dose of a 3rd Generation Cephalosporin
 (Cefotaxime) and Metronidazole were administered. According to a randomized list patients
 were assigned to one of the two study groups previous to his/her skin incision. The surgical
 and skin closure technique were standardized and verified by the protocol author previous to
 the development of any appendectomy by the eight surgeons included in the study.

 A Rochy-Davis incision was performed in all cases and aspiration of purulent liquid when
 required. Stump management with Halsted or Pouchet technique was done. Abdominal cavity was
 cleaned only with gauze pads, no drain were placed. After aponeurosis closure with
 Polyglactina 910 #1 continuous point, wound lavage with NaCl 0.9% solution was performed.
 Dermis was closed with Polyglactina 910 #3-0. In Group A Polyglactina 910 # 3-0 intradermic
 continuous point was done. In Group B skin closure with Nylon #3-0 separated stitches was
 achieved.

 Liquid diet was ingested 8 hours after surgery and progressed to normal if tolerated. In
 cases of complicated appendicitis antibiotics were continued four to five days and for
 uncomplicated appendicitis only by 2 days or until inflammatory systemic response signs were
 absent. When diet was tolerated and systemic response signs were absent discharge was
 accomplished.

 Surgery incision was evaluated daily until discharge and in extern consult at 7 and 30 days
 after surgery. In case of group B stitches removal were done at 10 days after surgery.

 Days of evolution (DOE) previous to appendicitis diagnose, use of antibiotics previously,
 complicated or uncomplicated appendicitis, surgery time and wound complications like skin
 infection, dehiscence, seroma or abscess were registered in each case.

 Database was performed and the statistical program SPSS version 22.0 for Mac IOS 7.0 was used
 to perform statistical data analysis. Complications, surgical and general characteristics
 were registered and compared between the groups using X2 test. A multivariate analysis was
 performed for independent variables and the possible association with complications.
Inclusion Criteria:

 -  Both gender

 -  Appendicitis diagnosis

 -  Informed consent signed

 -  0-60 age year old

 -  surgical confirmation of acute appendicitis

 -  Antibiotic prophylaxis

 Exclusion Criteria:

 -  Appendicitis diagnosis in patients >60 years old

 -  No antibiotic prophylaxis

 -  No informed consent signed