Introduction Appendectomy is still one of the most commonly performed emergency surgical procedures worldwide. Despite the use of antibiotics and peri-operative care, post- operative surgical wound infection (SWI) remains the most common post-operative complication. 1 Delayed Primary Closure (DPC) had been advocated for most of appendectomy wounds, especially in cases of complicated appendicitis. 2,3 Primary Closure (PC) has been in use by many surgeons for both simple and complicated appendicitis and has more or less developed as a consensus in paediatric cases. 4-6 Although PC for complicated appendicitis in adults has been advocated recently to reduce morbidity and cost (mainly due to the daily change of dressing and hospital care), 7-9 yet it has to gain the status of a consensus because of previous perception of increased rate of SWI in cases of PC as compared to DPC in cases of complicated appendicitis. 3 In this study we compared the rate of SWI after appendectomy in complicated appendicitis, the length of stay (LOS) in the hospital (indirectly depicting the cost of treatment) and patient's convenience on 100 mm Visual Analogue Scale (VAS). Methods The randomised control, multi-centre trial was done at CMH, Kharian, and CMH, Malir, from 5th June, 2006 to 10th September 2009. All the surgeries were done by the same surgeon (posted first at CMH Kharian and then at CMH, Malir). Inclusion criteria involved patients of both genders, older than 15 years undergoing appendectomy through grid iron or Lanz incision and having per-operative findings of complicated appendicitis (grossly inflamed, gangrenous or perforated appendix). Patients undergoing incidental appendectomies, having per-operative findings of normal appendix, appendicular mass or any other pathology with or without appendicitis were excluded. After taking informed consent, a detailed proforma regarding comorbids and any Vol. 62, No. 6, June 2012 596 Comparison of rate of surgical wound infection, length of hospital stay and patient convenience in complicated appendicitis between primary closure and delayed primary closure Khizar Ishtiaque Khan, 1 Shahid Mahmood, 2 Muhammad Akmal, 3 Ahmed Waqas 4 Department of Surgery, Combined Military Hospital, Malir, Karachi, 1,2 AFIU, Rawalpindi, 3 Department of Surgery, Combined Military Hospital, Rawalpindi. 4 Corresponding Author: Khizar Ishtiaque Khan. Email: khizarikhan@yahoo.com Abstract Objective: To compare the difference in the rate of surgical wound infection, patient's convenience and length of hospital stay between Primary Closure and Delayed Primary Closure in cases of complicated appendicitis in adults. Methods: This randomised control trial was conducted at the Combined Military Hospital, Kharian and Malir from June 5, 2006, to September 10, 2009. Patients > 15 years of both gender who underwent appendectomy through grid iron or Lanz incision and having complicated appendicitis were included. The 100 patients who were included in the study out of the initial size of 393, were randomised into two equal groups of 50 each (Group A: Primary Closure; Group B: Delayed Primary Closure) using a computer-generated table. All the surgeries were done by the same surgeon and the operative steps and antibiotic coverage were standardised. The rate of surgical wound infection, patient's convenience (on visual analogue scale in mm) and the length of hospital stay were recorded. Data was analysed using SPSS version 11, and p value was calculated. Results: Demographic data, comorbids and medication of both the groups was comparable. There was no significant difference in rate of surgical wound infection (p > 0.05). The difference in patient's convenience and length of hospital stay were significant (p < 0.05), showing superiority of Primary Closure over Delayed Primary Closure with no added morbidity/mortality. Conclusion: Primary Closure in complicated appendicitis not only reduces the cost of treatment, but is also more convenient and satisfying for the patients, with no added risk of surgical wound infection. Keywords: Appendicitis, Primary closure, Delayed primary closure (JPMA 62: 596; 2012). Original Article