Analysis of Outcomes Using Intraoperative Irrigation and Drainage for Complicated Appendicitis

Abstract

Background: The practice of irrigation and/or intraoperative peritoneal drain placement during an appendectomy for complicated appendicitis is currently controversial. This study was aimed at delineating the relationship between the practice of intraoperative drain placement and/or irrigation and patient outcomes for complicated appendicitis cases. Methods: A retrospective study of patients presenting with acute complicated appendicitis, which was defined as perforated or gangrenous, was conducted (n = 225). The primary outcome was defined as the presence of postoperative abscess or sepsis, while the secondary outcome measured was length of hospital stay. Results: Patients who received intraoperative drain placement had an increased risk of postoperative abscess (odds ratio (OR) = 13.33, P < 0.001) and sepsis (OR = 11.37, P = 0.026). There was no significant difference in primary outcomes with irrigation. Patients who received irrigation had a longer length of stay (7.59 vs. 4.69 days, P = 0.001) as did those who received an intraoperative drain (7.61 vs. 5.33 days, P = 0.01). Conclusions: In this study, irrigation did not change the OR of sepsis and postoperative abscess. However, placement of an intraoperative drain increased both the rates of sepsis and postoperative abscesses, indicating possible increase in postoperative complications with intraoperative drains when compared with no drains.

Is Abdominal Drain Necessary after Laparoscopic Appendectomy for Complicated Appendicitis?

“…However, when it comes to the management of complicated appendicitis either open or laparoscopic, surgeons debate about the use of some intraoperative techniques as the irrigation or the use of intraabdominal drain (14). The later had long history with conflicting viewpoints, Wiliam Halsted stated, "No drainage at all is better than the ignorant employment of it" (15) while Robert Tait was against Halsted's opinion as he stated, "When in doubt drain!"…”