Andrea Pakula, MD MPH, Amber Jones, MSIV, Ray Chung, MD FACS. Kern Medical Center
Background: Laparoscopic appendectomy has become the treatment of choice for acute appendicitis with equal or better outcomes than traditional open appendectomy. Laparoscopic appendectomy in patients with gangrenous or perforated appendicitis carries an increased rate of pelvic abscess formation, requiring reoperation or percutaneous (IR) drainage when compared to open appendectomy. We hypothesized that routine placement of pelvic Jackson-Pratt drains in gangrenous or perforated appendicitis, and limited intra-abdominal irrigation, decreases pelvic abscess formation after laparoscopic appendectomy in these patients.
Methods: Following IRB approval, charts of 283 patients undergoing laparoscopic appendectomy between 01/07 and 02/10 were reviewed. Only patients with findings of a perforated or gangrenous appendix were included. Patients were separated into two groups, Group 1: JP drain(s) placed with limited localized irrigation; Group 2: no JP drain, irrigated ad lib by the operating surgeons. Data collected included intra-abdominal or pelvic abscess postoperatively, IR drainage of the abscess, hospital length of stay, and the use of antibiotics. Clinic follow-up notes were reviewed to evaluate length of drainage and effectiveness of treatment.
Results: A total of 121 patients underwent laparoscopic appendectomy with findings of a perforated or gangrenous appendix from January 2007 to February 2010. 29 patients had placement of JP drains (Group 1) and 92 patients did not have a Jackson Pratt drain placed (Group 2). 18/92 (20%) of the Group 2 patients developed pelvic abscesses requiring IR drainage. 0/29 (0%) of Group 1 patients developed pelvic abscess. However, one patient in Group 1 developed a subphrenic abscess requiring IR drainage. Since the JP drain was not intended to prevent subphrenic abscesses, this patient was not included in our analysis. The Fisher’s Exact Test was used for our statistical analysis and we found the two-tailed probability to be 0.01. This is statistically significant when a p-value of <0.05 was used.
Conclusions: Use of Jackson Pratt drainage in patients with perforated or gangrenous appendicitis, who undergo laparoscopic appendectomy have a decreased rate of pelvic abscess/infection. Limited and localized intra-abdominal irrigation may limit dissemination of contamination and further decrease pelvic abscess formation. The need for treatment with IR drainage is decreased. The hospital length of stay is also decreased in the patients who have JP drains placed at time of operation. We therefore recommend the routine use of JP drainage of the pelvis after laparoscopic appendectomy for gangrenous or perforated appendicitis.
Program Number: S121