Comparison of surgical site infection between the primary and delayed primary closure in patients with complicated appendicitis; a Randomized clinical trial

Background and aims: Acute appendicitis is one of the common surgical emergencies. Surgical wounds after complicated (perforated/gangrenous) usually are managed with delayed primary closure (DPC) rather than primary closure (PC); however, choosing of the best closure method is controversial. The aim of this study was to compare the difference in the rate of surgical wound infection between the primary closure and delayed primary closure after complicated appendicitis.Materials and methods: This randomized clinical trial was conducted on patients who referred to the emergency department of Loghman Hakim hospital with the chief complaint of acute appendicitis from February 2014 to Feb 2018. The inclusion criteria were perforated and gangrenous appendicitis. The patients were divided randomly into to equal group based on the flipping coin. Demographic features, the rate of surgical site infection, hospitalization time in the primary closure and delayed primary closure groups compared with each other.Results: Sixty-nine patients include in the final analysis. Thirty-five patients were in the primary closure group and 34 patients were in the delayed primary closure group. Surgical site infection was observed in 6 patients, including 4 patients in the primary closure group and 2 patients in the delayed primary closure group (P value = 0.66). In addition, the hospitalization period was 3.5 ± 0.42 and 5.30 ± 0.21 in the primary closure and in the delayed primary closure respectively (P value = 0.001).Conclusion: There are no differences between the primary closure and delayed primary closure in the context of surgical site infection. However, the hospitalization time will be longer in the delayed primary closure of the complicated appendicitis wound.