Research hypothesis:

Does delayed primary wound closure after appendectomy in adults with complicated appendicitis reduce postoperative superficial surgical site infection compare to primary wound closure.

Study design:

This study is a multicenter randomized controlled trial of delay versus primary wound closure in complicated appendicitis.

Setting:

Thammasat Hospital, Ramathibodi Hospital, Chonburi Hospital, Chonpratarn Hospital, Vachira Hospital, and Pathumthani Hospital

Participants:

Adult patients age 18 years or older and non-pregnant in women who have been diagnosed as gangrenous or ruptured appendicitis.

Outcome:

Superficial surgical site infection

Period of study:

August 2012 - August 2014

Inclusion criteria

1. Adult patients age 18 years or older

2. Have been diagnosed as gangrenous or ruptured appendicitis base on clinical criteria with the following conditions

   a.Gangrenous appendicitis i.Erythematous or swelling of appendix and ii.Appearance of necrotic wall (dark, grayish color) b.Ruptured appendicitis i. Erythematous or swelling of appendix and ii.Appearance of hole in an appendix or iii.Rupture of appendix during a procedure c.Appearance of frank pus

3. Non-immunocompromised hosts which include

   1. AIDS
   2. History of end-stage renal disease (ESRD)
   3. History of autoimmune disease (SLE)
   4. Taking immunosuppressive agents (e.g, steroids, Cyclophosphamide, Tacrolimus, Mycophenolate mofetil)
   5. Cirrhosis with ascites
   6. Morbid obesity (BMI > 40 kg/m2)

4. Non-pregnant women

5. Willing to participate and provide written informed consent