Could an abdominal drainage be avoided in complicated acute appendicitis? Lessons learned after 1300 laparoscopic appendectomies

Int J Surg. 2016 Dec;36(Pt A):40-43. doi: 10.1016/j.ijsu.2016.10.013. Epub 2016 Oct 12.

Abstract

Introduction: Complicated appendicitis (CA) may be a risk factor for postoperative intra-abdominal abscess formation (IAA). In addition, several publications have shown an increased risk of postoperative collection after laparoscopic appendectomy. Most surgeons prefer to place a drain to collect contaminated abdominal fluid to prevent consequent abscess formation. We aimed to evaluate the utility of placing an intra-abdominal drain in laparoscopic appendectomy for complicated acute appendicitis.

Material and methods: From January 2005 to June 2015 all charts of consecutive patients who underwent laparoscopic appendectomy for CA were revised. CA was defined as a perforated appendix with associated peritonitis. The sample was divided into two groups, G1: intra-abdominal drain and G2: no drain. Demographics, operative factors and 30-day postoperative complications were analyzed.

Results: In the study period 1300 laparoscopic appendectomies were performed. Laparoscopic findings showed that 17.3% of the surgeries were for complicated acute appendicitis (225 patients). Fifty-six patients (25%) were in G1 and 169 patients (75%) in G2. No significant differences in clinical presentation and demographics were found (p: NS). G1 had an increased conversion rate (G1: 19.6% vs. G2: 7.1%; p: 0.007). No differences were found in the overall morbidity (G1: 32.1% vs. G2: 21.3%, p: NS). The rate of postoperative IAA was 14.2% in G1 and 8.9% in G2 (p: NS). Length of stay was higher in G1 (G1: 5.2 days vs. G2 2.9 days, p: 0.001). There was no mortality in either group.

Conclusion: The placement of intra-abdominal drain in complicated acute appendicitis may not present benefits and may even lengthen hospital stay. These observations suggest that there is no need of using a drain in laparoscopic appendectomy for complicated acute appendicitis.

Keywords: Complicated acute appendicitis; Drain; Laparoscopic appendectomy.

MeSH terms

  • Abdominal Abscess / epidemiology
  • Abdominal Abscess / etiology
  • Abdominal Abscess / prevention & control*
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Appendectomy / adverse effects*
  • Appendectomy / methods
  • Appendicitis / complications
  • Appendicitis / surgery*
  • Drainage / adverse effects
  • Drainage / methods*
  • Female
  • Humans
  • Laparoscopy / adverse effects*
  • Laparoscopy / methods
  • Length of Stay
  • Male
  • Middle Aged
  • Peritonitis / etiology
  • Postoperative Complications / etiology
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome
  • Young Adult