Prevention of infectious complications after laparoscopic appendectomy for complicated acute appendicitis--the role of routine abdominal drainage.
OBJECTIVE
Complicated acute appendicitis is still associated with an increased morbidity. If laparoscopy has been accepted as a valid approach, some questions remain concerning intra-abdominal abscess formation. Routine prophylactic drainage of the abdomen has been proposed. However, this practice remains a matter of debate, poorly validated in the literature. With the present study, we investigated the impact of drainage in laparoscopic appendectomy for complicated appendicitis.


METHODS
This is a case match study of consecutive patients operated on by laparoscopy in a single institution. One hundred and thirty patients operated for complicated appendicitis (local peritonitis without perforation, with perforation, or with periappendicular abscess) with prophylactic intraperitoneal drainage were matched one by one to 130 patients operated without drainage. Uncomplicated appendicitis and generalized peritonitis were excluded. Primary endpoint was surgical complications and secondary endpoints were transit recovery time and length of hospital stay.


RESULTS
Patients without drain had significantly less overall complications (7.7% vs. 18.5%, p = 0.01). Moreover, the absence of drainage was of significant benefit for transit recovery time (2.5 vs. 3.5 days, p = 0.0068) and length of hospital stay (4.2 vs. 7.3 days, p < 0.0001).


CONCLUSIONS
No benefits were observed for prophylactic drainage of the abdominal cavity during emergency laparoscopic treatment of complicated appendicitis. For this reason, this practice may be abandoned.
Allemann
Pierre
P
Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois, University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
Probst
Herve
H
Demartines
Nicolas
N
Schäfer
Markus
M
D018784:Abdominal Abscess / Q000601:surgery*; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis; D001062:Appendectomy / Q000009:adverse effects*; D001064:Appendicitis / Q000601:surgery*; D016022:Case-Control Studies; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control*; D013530:Surgical Wound Infection / Q000517:prevention & control*; D055815:Young Adult