Effect of peritoneal non-closure and closure during open appendectomy on post-operative pain: a randomized, double-blinded study.

BACKGROUND: Closure of the peritoneum has been a standard practice in appendectomy. However, it has been proposed that closure of the peritoneum following any abdominal surgery is more likely to give rise to adhesions and increased postoperative pain. This study was based on the hypothesis that peritoneal non-closure would result in decreased postoperative pain without causing any significant increase in complications like surgical site infection or wound dehiscence. OBJECTIVE: The primary objective of this study was to compare the pain scores in patients undergoing open appendectomy and peritoneal closure, with non-closure using the visual analogue scale (VAS) on postoperative day 1. RESULTS: Median VAS score on postoperative day 1 was found to be 4 (3,4) in the patients where the peritoneum was left open as compared to 5 (4,5) in patients where the peritoneum was closed (p < 0.001). Similarly, on postoperative day 2, the median VAS score in the peritoneum closure group was 4 (3,4) as compared to 3 (3,5) in the non-closure group. 29 out of 69 patients (42%) in the peritoneal closure group required rescue analgesia as compared to 11 out of 71 patients (15.5%) in the group with non-closure of the peritoneum (p < 0.001). The median duration of analgesia received, across both study groups was found to be 5 days. CONCLUSION: This study showed that peritoneal non-closure during open appendectomy is associated with less post-operative pain. It also significantly reduces the need for rescue analgesia and decreases the total number of days of analgesia used. There is no significant increase in surgical site infection and wound dehiscence after 30 days through the above intervention, implying no difference in morbidity with the intervention.