Abdominal drainage to prevent intra-peritoneal abscess after appendectomy for complicated appendicitis (A Cochrane review)

Yao Cheng, Xianze Xiong, Hui Ye, Nansheng Cheng. West China Hospital, Sichuan University.

Background:Appendectomy is performed primarily for acute appendicitis. Patients who undergo appendectomy for complicated appendicitis, defined as gangrenous or perforated appendicitis, are more likely to suffer from postoperative complications. The routine use of abdominal drainage to reduce postoperative complications after appendectomy for complicated appendicitis is controversial. The aim of this systematic review is to assess the safety and efficacy of abdominal drainage to prevent intra-peritoneal abscess after appendectomy for complicated appendicitis.

Methods: The Cochrane Library (Issue 11, 2012), MEDLINE (1946 to November 2012), EMBASE (1974 to November 2012), Science Citation Index Expanded (1900 to November 2012), and Chinese Biomedical Literature Database (1978 to November 2012) were searched to identify relevant randomized controlled trials (RCTs).

Results:Five RCTs involving 505 patients with complicated appendicitis were included in the review. The patients were randomized to the drainage group (n=243) and the no drainage group (n=262) after emergency open appendectomies. All of the trials were of high risk of bias. There were no significant differences between the two groups in the rates of intra-peritoneal abscess, wound infection, morbidity, or mortality when the random-effects model was adopted. The rates of wound infection and morbidity were significantly higher in the drainage group when the fixed-effect model was used. The hospital stay was longer in the drainage group than in the no drainage group.

Conclusions:Abdominal drainage after an emergency open appendectomy delays hospital discharge and may increase the rates of wound infection and morbidity for patients with complicated appendicitis. Based on five high risk of bias trials, there is no clear evidence to support routine abdominal drainage to prevent intra-peritoneal abscess after open appendectomy for complicated appendicitis. The role of abdominal drainage after laparoscopic appendectomy for complicated appendicitis requires further assessment.

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