Laparoscopic Antibiotic Lavage to Prevent Intra-abdominal Abscess Formation in Complicated Appendicitis

Inclusion criteria

• All patients ≥ 8 years with a preoperative diagnosis of acute appendicitis either with or without clinical or radiological suspicion of CA undergoing a laparoscopic appendectomy for intra-operative confirmed CA that can provide a signed written consent form.

Exclusion criteria

• Age under 8 years;
• Not able to give informed consent (language barrier, legally incapable)
• Any contraindication for the use of the study medication:

• Hypersensitivity to clindamycin or to any of the excipients benzyl alcohol, sodium edetate, water, or to lincomycin;
• Hypersensitivity to gentamicin or to sodium metabisulfite: particularly in asthmatic patients, this may trigger bronchospasms and anaphylactic shock or to any of the excipients: disodium edetate, sodium hydroxide, sodium metabisulfite (E223), water for injections;
• Severe sepsis defined as sepsis-induced tissue hypoperfusion or organ dysfunction that includes any of the following thought to be caused by the infection:

• Sepsis-induced hypotension
• Lactate above upper limits laboratory normal
• Urine output <0.5 mL/kg/h for more than 2h despite adequate fluid resuscitation
• Acute lung injury with PaO2/FiO2 <250 in the absence of pneumonia as infection source
• Acute lung injury with PaO2/FiO2 <200 in the presence of pneumonia as infection source
• Creatinine >2.0 mg/dL (176.8 μmol/L)
• Bilirubin >2mg/dL (34.2 μmol/L)
• Platelet count < 100,000 μL
• Coagulopathy (international normalized ratio (INR) > 1.5);
• ASA IV score;
• Known malignancy;
• Renal dysfunction (i.e. eGFR ≤ 60);
• Immunocompromised patients (i.e. hematological malignancies, HIV/AIDS, bone marrow transplantation, splenectomy, genetic disorders such as severe combined immunodeficiency, chemotherapy, dialysis, solid organ transplant, and immunosuppressant use (such as corticosteroids in patients with rheumatoid arthritis));
• Pregnancy;
• Known allergies to either gentamicin or clindamycin;
• Known colonization of bacteria resistant to either gentamicin or clindamycin;