Appendicitis, seasonal incidence and postoperative wound infection

Abstract

In this series of 404 appendicectomies there was found to be a seasonal incidence of acute appendicitis (nearly two-thirds of the cases occurring between October and March). The environmental factor which appears to be linked with this increase in incidence is a lowering of humidity. If strict surgical principles are followed in relation to peritoneal (and wound) toilet, the indications for the use of a drain tube are very few indeed; moreover there is a direct relationship between the use of a drain tube and wound infection, particularly in the presence of excess peritoneal fluid. It has been shown that the turbidity of the excess peritoneal fluid is not related to its pathogenicity as regards wound infection. It has also been shown that the more severe the appendicular pathology, the greater is the risk of development of wound infection. It is evident from this series of appendicectomies that immediate postoperative antibiotics play no part in the prevention of wound infection, and may even confer an increased risk in the development thereof. It is noteworthy that the gridiron incision which had to be extended, and the paramedian incisions, have the highest incidence of wound infection.