{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T09:32:13Z","timestamp":1793179933925,"version":"4.5.0"},"reference-count":37,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Surgical Infections"],"published-print":{"date-parts":[[2026,12,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Surgical site infection (SSI) is a common complication after open appendectomy. The effectiveness of intra-operative antibiotic irrigation compared with saline irrigation remains uncertain. To evaluate the efficacy and safety of antibiotic irrigation versus saline irrigation during open appendectomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted a systematic review and random-effects meta-analysis of randomized controlled trials comparing antibiotic irrigation with saline irrigation in patients undergoing open appendectomy. The literature search identified 40 records; after duplicate removal and title\/abstract screening, 15 articles underwent full-text review, and five randomized controlled trials (RCTs) were included. Risk of bias was assessed using the ROB-2 tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Five RCTs involving 1,080 patients were included (533 antibiotic irrigation; 547 saline), conducted in Saudi Arabia, Egypt, Iran, Iraq, and Nepal. The weighted mean age was 28.20 years, and most participants were male (54.4% vs. 57.5% in intervention and control groups). The mean follow-up was 1.1 months. All trials were rated low risk of bias. SSI occurred in 4.8% (26\/533) of patients receiving antibiotic irrigation versus 8.9% (49\/547) receiving saline. Antibiotic irrigation significantly reduced SSI risk (RR 0.60, 95% CI: 0.36 to 0.99; p = 0.05) with minimal heterogeneity (\n                      <jats:italic toggle=\"yes\">\n                        I\n                        <jats:sup>2<\/jats:sup>\n                        =\n                      <\/jats:italic>\n                      6.87%). Leave-one-out analyses suggested fragility, with significance not consistently maintained when individual studies were omitted. Trial sequential analysis crossed the conventional boundary but not the monitoring boundary, and the required information size was not reached, indicating inconclusive evidence. Doi plot analysis showed minor asymmetry (LFK index \u22121.90). No significant differences were observed for abdominal abscess, post-operative ileus, length of stay, or operative duration.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Antibiotic irrigation may reduce SSI after open appendectomy, but the evidence is fragile and remains insufficient by TSA. Future research should focus on minimally invasive appendectomy, with open-surgery studies reserved for settings where it remains common.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10962964261484813","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T05:37:26Z","timestamp":1788241046000},"page":"674-683","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Antibiotic Versus Saline Irrigation During Open Appendectomy: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Controlled Trials"],"prefix":"10.1177","volume":"27","author":[{"given":"Abdullatif","family":"Alfehaid","sequence":"first","affiliation":[{"name":"School of Medicine, Royal College of Surgeons in Ireland, Medical University of Bahrain, Busaiteen, Bahrain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2337-6588","authenticated-orcid":false,"given":"Abdullah M.","family":"Alharran","sequence":"additional","affiliation":[{"name":"College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saud Jaber","family":"Almarri","sequence":"additional","affiliation":[{"name":"Kuwait Institute for Medical Specialization, Kuwait City, Kuwait."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yousef M.","family":"Alajmi","sequence":"additional","affiliation":[{"name":"College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fahad A.","family":"Alsaid","sequence":"additional","affiliation":[{"name":"College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Almutawtah","sequence":"additional","affiliation":[{"name":"Kuwait Institute for Medical Specialization, Kuwait City, Kuwait."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salel M.","family":"Sanaa","sequence":"additional","affiliation":[{"name":"Kuwait Institute for Medical Specialization, Kuwait City, Kuwait."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monerah Falah","family":"Alajmi","sequence":"additional","affiliation":[{"name":"Kuwait Institute for Medical Specialization, Kuwait City, Kuwait."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2025.6218"},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2019-034266"},{"key":"e_1_3_2_4_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.92258"},{"key":"e_1_3_2_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.0904"},{"key":"e_1_3_2_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2024.0775"},{"key":"e_1_3_2_7_1","unstructured":"6.Table 1 Summary of core topics research questions and recommendations for the prevention of surgical site infection. 2018. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK536430\/table\/fm-ch1.tab1\/ [Last accessed: February23 2026]."},{"key":"e_1_3_2_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13756-024-01458-6"},{"key":"e_1_3_2_9_1","unstructured":"8.Antibiotics most responsible for drug resistance are overused\u2014WHO report n.d. Available from: https:\/\/www.who.int\/news\/item\/29-04-2025-antibiotics-most-responsible-for-drug-resistance-are-overused\u2013-who-report [Last accessed: February23 2026]."},{"key":"e_1_3_2_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/9781119536604"},{"key":"e_1_3_2_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_3_2_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"e_1_3_2_13_1","unstructured":"12.New in Stata 19 | Stata n.d. Available from: https:\/\/www.stata.com\/new-in-stata\/ [Last accessed: March20 2026]."},{"key":"e_1_3_2_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-017-0315-7"},{"key":"e_1_3_2_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjebm-2018-111107"},{"key":"e_1_3_2_16_1","doi-asserted-by":"publisher","DOI":"10.5144\/0256-4947.1994.233"},{"key":"e_1_3_2_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2020.07.057"},{"key":"e_1_3_2_18_1","doi-asserted-by":"publisher","DOI":"10.5812\/ircmj.12732"},{"key":"e_1_3_2_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/hsr2.71143"},{"key":"e_1_3_2_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12893-025-03127-w"},{"key":"e_1_3_2_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2021.106136"},{"issue":"3","key":"e_1_3_2_22_1","first-page":"153","article-title":"Incidence and risk factors for post-appendectomy emergency surgical site infections","volume":"13","author":"Sarafi M","year":"2025","unstructured":"21.Sarafi M, , Azimi B, , Karimian M, et al. Incidence and risk factors for post-appendectomy emergency surgical site infections. Bull Emerg Trauma 2025;13(3):153\u2013157; doi: 10.30476\/beat.2025.106191.1582","journal-title":"Bull Emerg Trauma"},{"key":"e_1_3_2_23_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-79939-2"},{"key":"e_1_3_2_24_1","doi-asserted-by":"publisher","DOI":"10.61919\/n0sz7e09"},{"key":"e_1_3_2_25_1","first-page":"125","article-title":"Intra-operative wound irrigation with normal saline solution versus topical antibiotics to avoid wound infection","volume":"74","author":"Khan S","year":"2024","unstructured":"24.Khan S, , Awan AS, , Asad H, et al. Intra-operative wound irrigation with normal saline solution versus topical antibiotics to avoid wound infection. 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