COMPARISON OF NON-INVAGINATION VERSUS INVAGINATION OF APPENDIX STUMP FOLLOWING APPENDICECTOMY IN TERMS OF WOUND INFECTION

ABSTRACT
Background: Acute appendicitis remains the most common abdominal surgical emergency and the individual lifetime
risk of appendicectomy is 8.6% and 6.7% among males and females respectively. Appendicectomy remains the standard
treatment for acute appendicitis which is performed by both open and laparoscopic approach. The technique of
appendicectomy has been reported to vary from surgeon to surgeon or from center to center, starting from skin incision
to the ligation and invagination of appendicular stump and so on.
Objective: Objective of study is to compare results of non invagination versus invagination of appendix stump in terms
of post operative wound infection.
Material and Methods: This prospective randomized controlled trial was conducted at the Department of Surgery,
Khyber Teaching Hospital, Peshawar over a period of three years from May 2013 to April 2016. The patients were
divided in two groups in which Group A were those in which stump was not invaginated while group B have stump
invaginated. All operated patients of appendectomy of either gender and age ≥14 years were included in the study
while all patients with previous abdominal surgery, appendectomy done through incision in area other than right iliac
fossa, appendicular mass, perforated appendix with localized or generalized peritonitis and patients with comorbidities
were excluded. Patients particulars and rates of infection in both groups of patients were documented on pre designed
proforma. Postoperatively all patients were observed for wound infection in ward and in OPD for 2 weeks . All the results
were analyzed by SPSS version 16 and represented in the form of tables.
Results: Total 562 patients (281 in each group) were included in the study. Patients were randomized into two groups
by lottery method. 281 patients were included in each group.
Results: Our study shows that in Non-invagination group 6% patients had wound infection while 94% patients didn’t
have wound infection. Where as in stump invagination group 12% patients had wound infection and 88% patients didn’t
have wound infection. All the patients were in the age range of 15 to 45 years with mean 32 years ± 1.26 and 35 years ±
2.73 in groups A and B respectively. Post operatively wound infection was common in group B patients having number
of 34(12%) overall and the most common age group which effected was in age range of 36 to 45 years 15(24%) out of
62 patients. Based on gender 19(13.19%) male patients out of 163 developed wound infection in group B which was
more common than females in the same group and from group A patients as a whole.
Conclusion: Our study concludes that non-invagination is more effective than invagination of appendix stump following
open appendectomy in terms of wound infection.