Is it necessary to use specimen retrieval bag for reducing surgical site infection in laparoscopic appendectomy?A randomized controlled trial.

Background: The aim of the study was to investigate the comparison the effects of the extraction of specimen by using a specimen retrieval bag (SRB) or direct extraction through trochar in terms of surgical site infection (SSI) in patients who underwent laparoscopic appendectomy.

Methods: A total of 165 patients were randomly allocated into two groups. A SRB was used in 77 patients (Group 1, 46.7%) and not used in 88 patients (Group 2, 53.3%). Demographics, comorbid diseases, laboratory results, preoperative diameter of appendix, intraoperative observations, intraoperative procedures, hospitalization times, SSIs, pathology results, culture results, and findings of the patients who developed complications and the treatments given to the patients due to complications during the post-operative period were recorded.

Results: The mean age of the patients was 33.95 SD 13.25 (min-max: 18-78) years. No significant difference was observed in the demographics, hospitalization times, distribution of the incidence rates of diabetes mellitus, perioperative perforation, perioperative fluid/abscess, drain insertion, aspiration-irrigation, superficial incisional SSI, drainage requirement, leakage, positive culture results, and post-operative intra-abdominal infection (p>0.05) between the groups. Neutrophil and leukocyte values were statistically significantly different between the groups (p=0.044 and p=0.012, respectively). There was a significant difference between the two groups in terms of the complicated appendicitis (p=0.040). There was no significant difference in terms of the positive culture results and incidence of post-operative intra-abdominal infection between the patients in Group 1 and Group 2 in both the complicated and uncomplicated appendicitis groups (p>0.05). The difference between the patients in Group 1 and Group 2 regarding the incidence of superficial incisional SSI was significant in the uncomplicated appendicitis group (p=0.037), whereas not significant in the complicated appendicitis group (p=1.000). In the multivariate model, only perioperative perforation was observed to be the effective parameter on post-operative intra-abdominal infection at the p<0.05 level (p=0.045).

Conclusion: The results of the present study revealed that the use of SRB does not prevent microbial seeding in patients who underwent laparoscopic appendectomy; therefore, it was concluded that using SRB is not associated with SSI at laparoscopic appendectomy.