Abdominal Drainage After Laparoscopic Appendectomy in Children: An Endless Controversy?

Castro, Belén Aneiros; Cano, I; García, Andrés del Pozo; Yuste, Pedro; Ferrero, Eduardo; Gómez, Andrés

doi:10.1177/1457496918766696

Cited by 17 publications

(23 citation statements)

References 17 publications

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“…Aneiros Castro et al retrospectively analyzed 192 pediatric patients (mean age of 7.77 ± 3.4 years) undergoing early LA for perforated AA and reported that there were no statistically significant differences between the drain and no drain groups in the rate of IAA, SSI, and bowel obstruction. However, drains were statistically associated with an increased requirement for antibiotic and analgesic medication, fasting time, operative time, and length of hospital stay [ 177 ].…”

Section: Resultsmentioning

confidence: 99%

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

et al. 2020

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Background and aims: Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide. In July 2015, the World Society of Emergency Surgery (WSES) organized in Jerusalem the first consensus conference on the diagnosis and treatment of AA in adult patients with the intention of producing evidence-based guidelines. An updated consensus conference took place in Nijemegen in June 2019 and the guidelines have now been updated in order to provide evidence-based statements and recommendations in keeping with varying clinical practice: use of clinical scores and imaging in diagnosing AA, indications and timing for surgery, use of nonoperative management and antibiotics, laparoscopy and surgical techniques, intra-operative scoring, and perioperative antibiotic therapy.

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Section: Resultsmentioning

confidence: 99%

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

et al. 2020

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“…Complicated appendicitis is defined as the presence of a visible hole in the appendix, a fecalith in the abdomen detected intraoperatively, or an appendiceal perforation [ 1 ]. The development of a postoperative intra-abdominal abscess has been reported in 1.7–30% of patients with complicated appendicitis [ 2 – 6 ], but the advantages of drain tube placement after appendectomy remain unclear. After appendicitis surgery, the abdominal cavity must be cleaned by extensive irrigation and suction to remove intraabdominal pus or dirty ascites, and thus prevent intra-abdominal abscess formation.…”

Section: Introductionmentioning

confidence: 99%

Inappropriate manipulation and drainage exacerbate post-operative pain and prolong the hospital stay after laparoscopic appendectomy for pediatric complicated appendicitis

et al. 2021

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Background This study examined whether drain placement or not is associated with the postoperative outcomes of pediatric patients following trans-umbilical single-port laparoscopic appendectomy (TUSPLA) for complicated appendicitis. Methods The medical records of pediatric patients undergoing TUSPLA for acute complicated appendicitis from January 2012 to September 2018 in Kaohsiung Chang Gung Memorial Hospital were reviewed retrospectively. They were classified according to whether they received passive drainage with a Penrose drain (Penrose group) (19), active drainage with a Jackson-Pratt drain with a vacuum bulb (JP group) (16), or no drain (non-drain group) (86). The postoperative outcomes of the three groups were compared. Results Postoperative visual analog scale pain score was significantly higher in the non-drain group than in either the JP group or Penrose group. Patients in the Penrose group had a significantly longer postoperative hospital stay than those in the non-drain group and a higher rate of intra-abdominal abscess, while patients in the JP group had a significantly shorter postoperative hospital stay; moreover, no patient in JP group developed a postoperative intra-abdominal abscess. Conclusions Compared to passive drainage with a Penrose drain or no drain, active drainage with a JP drain shorter the postoperative hospital stay and decreased the risk of postoperative intra-abdominal abscess.

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“…In a study, Castro et al found no difference between patients with and without drains in terms of postoperative morbidity development in patients who had undergone laparoscopic treatment for perforated appendicitis (32) . A recent Cochrane analysis found that placing drains in perforated appendicitis did not reduce the risk of morbidity, even increased 30-day morbidity with very little evidence (33) .…”

Section: Discussionmentioning

confidence: 96%

Risk Factors Affecting Postoperative Morbidity in Laparoscopic Treatment of Perforated Appendicitis, a Single Center Experience

Sürek¹,

Karabulut²

2020

BMJ

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Objective: Postoperative morbidity may occur more in laparoscopic treatment of perforated appendicitis than simple appendicitis. In this study, we aimed to investigate the risk factors affecting the development of morbidity in laparoscopic treatment of perforated appendicitis. Method: The files of patients who underwent laparoscopic appendectomy due to perforated appendicitis were analysed retrospectively. Finding of perforation has been documented by surgeons who performed surgery. Information on the patients such as age, gender, Charlson Comorbidity Index (CCI), body mass index (BMI), ASA scores, symptom onset time, time between hospital admission and surgery, surgical findings, perforation sites, type of surgery, stump closure materials, white blood cell counts, pathology results and postoperative morbidities were recorded. Data were compared between patients with and without morbidity, and multivariate regression analysis of variables with significant p value was performed. Results: The rate of morbidity development in laparoscopic treatment of perforated appendicitis was 22.14% (66/298). In multivariate regression analysis, the onset of symptoms longer than 72 hours, proximal perforation, grade 5 diffuse peritonitis in surgical finding according to Disease Severity Score (DSS), conversion from laparoscopic to open surgery and gangrene or necrosis in histopathological finding were found to be effective risk factors in the development of morbidity.

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Abdominal Drainage After Laparoscopic Appendectomy in Children: An Endless Controversy?

Abstract: The prophylactic use of abdominal drainage after laparoscopic appendectomy for perforated appendicitis in children does not prevent postoperative complications and may be associated with negative outcomes. Prospective randomized studies will be necessary to verify this question.

Cited by 17 publications

References 17 publications

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

Inappropriate manipulation and drainage exacerbate post-operative pain and prolong the hospital stay after laparoscopic appendectomy for pediatric complicated appendicitis

Risk Factors Affecting Postoperative Morbidity in Laparoscopic Treatment of Perforated Appendicitis, a Single Center Experience

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