title: Could an abdominal drainage be avoided in complicated acute appendicitis? Lessons learned after 1300 laparoscopic appendectomies.
abstract: BACKGROUND
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of General Surgery, Hospital Alemán of Buenos Aires, Argentina. Electronic address: fschlottmann@hotmail.com.
authors.forename: Francisco
authors.initials: F
authors.lastname: Schlottmann
authors.affiliation: Department of General Surgery, Hospital Alemán of Buenos Aires, Argentina.
authors.forename: Romina
authors.initials: R
authors.lastname: Reino
authors.affiliation: Department of General Surgery, Hospital Alemán of Buenos Aires, Argentina.
authors.forename: Emmanuel E
authors.initials: EE
authors.lastname: Sadava
authors.affiliation: Department of General Surgery, Hospital Alemán of Buenos Aires, Argentina.
authors.forename: Ana
authors.initials: A
authors.lastname: Campos Arbulú
authors.affiliation: Department of General Surgery, Hospital Alemán of Buenos Aires, Argentina.
authors.forename: Nicolás A
authors.initials: NA
authors.lastname: Rotholtz
mesh_terms: D018784:Abdominal Abscess / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy / Q000009:adverse effects* / Q000379:methods; D001064:Appendicitis / Q000150:complications / Q000601:surgery*; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Complicated acute appendicitis; Drain; Laparoscopic appendectomy