Randomized Trial of Primary Versus Delayed Closure of Contaminated Appendectomy Incisions

Wound infection is common following contaminated appendicectomy incisions in developing countries with an increased cost of treatment. We set out to determine the wound infection outcome and costs of managing contaminated appendicectomy incisions closed primarily as compared to those closed using a technique of delayed primary closure.Forty-ninepatients with acute uncomplicated appendicectomy were randomized into two groups. The first group had primary closure and the second group delayed primary closure of their incisions following operative management. Postoperative monitoring for wound infection was done for one month. The overall cost of wound management and the length of hospital stay were then determined. Twenty-five(51%) and 24 (49%) matched patients were assigned to the primary and delayed primary closure group respectively. Wound infection in both groups was20% and 4.2% respectively. The mean cost of wound management was fourteen thousand, seven hundred and sixty-four naira only (N 14,764.00), and twelve thousand, one hundred and forty-eight naira only (N 12, 148.33) respectively. The mean length of hospital stay was 3.20 days and 2.58 days respectively. In conclusion, primary closure and delayed primary closure of contaminated appendicectomy incisions result in similar wound infection outcomes, cost of wound management and length of hospital stay. However, there was a numerical trend in favour of delayed primary closure when the primary outcomes were considered. We recommend that in operative management of contaminated appendicectomy wounds, both methods of wound closure are acceptable and clinical judgement should guide the surgeon's choice.