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

Francisco Schlottmann, Romina Reino, Martin Galvarini, Jose Alvarez Gallesio, Rudolf Buxhoeveden, Ezequiel Sadava, Nicolas Rotholtz. Hospital Aleman of Buenos Aires

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

Methods and procedures: From January 2005 to June 2015 all charts of consecutive patients underwent to laparoscopic appendectomies of complicated acute appendicitis were revised. Complicated acute appendicitis was defined as perforated appendix with peritonitis. 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 period of the study 1300 laparoscopic appendectomies were performed. Laparoscopic findings showed 17.3% of 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. Decision making seems to be related to more complex cases at surgeon discretion. These observations suggest that there is no need of using a drain in complicated acute appendicitis and prospective investigations are warranted

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