Efficacy and safety of abdominal cavity cleansing with chlorhexidine for reducing surgical site infection in patients undergoing appendectomy

Juan Alberto Chue Serrano; Uriel Figueroa Quiñones; Sandra Ibáñez Ovando; Stephany Viveros Guerrero

doi:10.18203/2349-2902.isj20263333

Authors

Juan Alberto Chue Serrano Department of General Surgery, General Hospital No. 20 “La Margarita,” Mexican Social Security Institute, Puebla, Puebla, Mexico
Uriel Figueroa Quiñones Department of General Surgery, General Hospital No. 20 “La Margarita,” Mexican Social Security Institute, Puebla, Puebla, Mexico
Sandra Ibáñez Ovando Clinical Coordination of Health Education and Research, Family Medicine Unit No. 11, Mexican Social Security Institute, Puebla, Puebla, Mexico
Stephany Viveros Guerrero Department of General Surgery, General Hospital No. 20 “La Margarita,” Mexican Social Security Institute, Puebla, Puebla, Mexico

DOI:

https://doi.org/10.18203/2349-2902.isj20263333

Keywords:

Acute appendicitis, Surgical site infection, Chlorhexidine, Abdominal cavity cleansing, Appendectomy

Abstract

Background: Surgical site infection (SSI) remains a relevant postoperative complication after appendectomy. Intraoperative abdominal cavity cleansing is used in clinical practice, but the evidence supporting antiseptic solutions remains heterogeneous.

Methods: A prospective case-control study was conducted in adults undergoing appendectomy for acute appendicitis at a tertiary hospital in Puebla, Mexico. Patients received intraoperative abdominal cavity cleansing with either chlorhexidine or saline. The primary outcome was surgical site infection within 30 days. Patients were followed at 15 and 30 days postoperatively. Demographic, clinical, microbiological, and adverse-event data were collected. Associations were analyzed using odds ratios with 95% confidence intervals and Fisher’s exact test, with p<0.05 considered statistically significant.

Results: The median age was 37 years (IQR 26-51); 217 patients (55.5%) were women and 174 (44.5%) were men. Uncomplicated and complicated appendicitis occurred in 198 (50.6%) and 193 (49.4%) patients, respectively. Postoperative complications occurred in 97/192 (50.5%) patients in the chlorhexidine group and 58/108 (53.7%) in the saline group. Chlorhexidine showed a non-significant trend toward fewer complications (OR 0.88, 95% CI 0.55-1.41; p=0.63). Mean time to infection was 16.3±8.4 days. The most frequent positive isolate was Escherichia coli. No increase in adverse events was observed with chlorhexidine.

Conclusions: Abdominal cavity cleansing with chlorhexidine was clinically safe and showed a non-significant trend toward fewer postoperative complications compared with saline. These findings support further adequately powered randomized studies to define its role in SSI prevention after appendectomy.

References

Armstrong DG, Meyr AJ. Risk factors for impaired wound healing and wound complications. UpToDate. 2023. Available at: https://www.uptodate.com/contents/risk-factors-for-impaired-wound-healing-and-wound-complications Accessed on 09 July 2026.

Anderson DJ. Overview of control measures for prevention of surgical site infection in adults. UpToDate. 2024. Available at: https://www.uptodate.com/contents/overview-of-control-measures-for-prevention-of-surgical-site-infection-in-adults Accessed on 09 July 2026.

Bhat RA, Isaac NV, Joy J, Chandran D, Suresh V, Thomas S, et al. The effect of American Society of Anesthesiologists score and operative time on surgical site infection rates in major abdominal surgeries. Cureus. 2024;16(2):e55138.

Membrilla-Fernández E, Gómez-Zorrilla S, González-Castillo AM, Pelegrina-Manzano A, Guzmán-Ahumada J, Prim N, et al. Scientific evidence of the duration of antibiotic treatment in intra-abdominal infections with surgical focus control. Cir Esp (Engl Ed). 2022;100:608-13.

Akash A, Saxena N. Superficial surgical site infection in delayed primary vs primary wound closure in complicated appendicitis. Pol Przegl Chir. 2023;96(0):123-9.

Norman G, Atkinson RA, Smith TA, Rowlands C, Rithalia AD, Crosbie EJ, et al. Intracavitary lavage and wound irrigation for prevention of surgical site infection. Cochrane Database Syst Rev. 2017;10:CD012234.

Mueller TC, Kehl V, Dimpel R, Blankenstein C, Egert-Schwender S, Strudthoff J, et al. Intraoperative wound irrigation for the prevention of surgical site infection after laparotomy: a randomized clinical trial by CHIR-Net. JAMA Surg. 2024;159(5):484-92.

Emile SH, Elfallal AH, Abdel-Razik MA, El-Said M, Elshobaky A. A randomized controlled trial on irrigation of open appendectomy wound with gentamicin-saline solution versus saline solution for prevention of surgical site infection. Int J Surg. 2020;81:140-6.

Mueller TC, Nitsche U, Kehl V, Schirren R, Schossow B, Goess R, et al. Intraoperative wound irrigation to prevent surgical site infection after laparotomy (IOWISI): study protocol for a randomized controlled trial. Trials. 2017;18(1):410.

Wang J, Lv W, Xu S, Yang C, Du B, Zhong Y, et al. Intraoperative incision irrigation with high-volume saline reduces surgical site infection for abdominal infections. Front Surg. 2022;9:927896.

Mueller TC, Dimpel R, Kehl V, Friess H, Reim D. Surgical site infection prevention in abdominal surgery: is intraoperative wound irrigation with antiseptics effective? Protocol for a systematic review and meta-analysis. BMJ Open. 2023;13(2):e066140.

Bom WJ, Scheijmans JCG, Salminen P, Boermeester MA. Diagnosis of uncomplicated and complicated appendicitis in adults. Scand J Surg. 2021;110(2):170-9.

Lai SL, Chang CH, Lee PC, Ho CM, Wu JM, Lai HS, et al. Impact of preoperative factors and waiting time on post-appendectomy complications: a retrospective study. Perioper Med (Lond). 2024;13:8.

Obara H, Takeuchi M, Kawakubo H, Shinoda M, Okabayashi K, Hayashi K, et al. Aqueous olanexidine versus aqueous povidone-iodine for surgical skin antisepsis on the incidence of surgical site infections after clean-contaminated surgery: a multicentre, prospective, blinded-endpoint, randomised controlled trial. Lancet Infect Dis. 2020;20(11):1281-9.

Evans HL. Overview of the evaluation and management of surgical site infection. UpToDate. 2024. Available at: https://www.uptodate.com/contents/overview-of-the-evaluation-and-management-of-surgical-site-infection Accessed on 09 July 2026.

Caballero-Alvarado J, Torres VL, Peralta KL, Zavaleta-Corvera C. Complicated acute appendicitis with compromised appendiceal base: a review of surgical strategies. Pol Przegl Chir. 2023;96(0):65-70.

Firdos R, Abdi IH, Laghari QA, Sahito M, Kalhoro N, Memon SM. Correlation of surgical site infection (SSI) after appendicectomy with per-operative morphological appearance of appendix. Prof Med J. 2020;27(2):251-9.

Tenenhaus M, Rennekampff HO. Topical agents and dressings for local burn wound care. UpToDate. 2023. Available at: https://www.uptodate.com/contents/topical-agents-and-dressings-for-local-burn-wound-care Accessed on 10 July 2026.

Maemoto R, Noda H, Ichida K, Tamaki S, Kanemitsu R, Machida E, et al. Superiority trial comparing intraoperative wound irrigation with aqueous 10% povidone-iodine to saline for the purpose of reducing surgical site infection after elective gastrointestinal surgery: study protocol for a randomised controlled trial. BMJ Open. 2021;11(6):e051374.

Maemoto R, Noda H, Ichida K, Miyakura Y, Kakizawa N, Machida E, et al. Aqueous povidone-iodine versus normal saline for intraoperative wound irrigation on the incidence of surgical site infection in clean-contaminated wounds after gastroenterological surgery: a single-institute, prospective, blinded-endpoint, randomized controlled trial. Ann Surg. 2023;277(5):727-33.

Darouiche RO, Wall MJ Jr, Itani KMF, Otterson MF, Webb AL, Carrick MM, et al. Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med. 2010;362(1):18-26.