Tuesday, October 6, 2009

Appy Condoms

Dr Waxman's group in Santa Barbara, California has a paper out in Archives this week which makes a strong argument for the Alexis wound retractor when doing an open appendectomy. I use a wound retractor when doing laparoscopic colon resections but I had never heard of anyone using one for an appy. The paper is decent; it's a randomized controlled trial (total of 100 patients or so) comparing wound infection rates with and without the Alexis device. None of the wound-condom patients developed infections while 15% of the cases in the au naturel group were complicated by superficial wound infections.

The device only costs 20 bucks so you're not going to bankrupt the healthcare system by using it. But it just seems a little overwrought to me. Take out the damn appendix laparoscopically if you're worried about wound infections. Much more elegant anyway...


andy said...

It looks far too big for my usual appy incision.

Anonymous said...

It looks way too small for my usual condom.

Jeffrey Parks MD FACS said...

They have a small device that is supposed to accomodate 2.5-6cm incisions. So whatever that means...

I predicted you making that joke even while writing the post. Thanks for not letting me down.

Joseph Sucher, MD FACS said...

Classic Buckeye.

Just in case you missed it. Someone out there actually published a paper in support of laparoscopic appendectomy (in early perforated appendicitis of all things!).

Perforated appendicitis: is early laparoscopic appendectomy appropriate?

and this one out of China

Laparoscopic versus open appendectomy: a prospective
randomized comparison

I still wish I had time to go through the NSQIP dataset and crush that previous bogus article last year that tried to tell us that open appendectomy is better. Arrgh.