Evaluation of Drain Insertion After Appendicectomy for Complicated Appendicitis: A Systematic Review and Meta-Analysis

Abstract

This meta-analysis aims to evaluate the comparative outcomes of drain insertion versus no drain after appendicectomy for complicated appendicitis. A systematic search of PubMed, Cochrane Library and Scopus was conducted, and all studies comparing drain versus no drain after appendicectomy for complicated appendicitis were included. Abdominal collection, surgical site infection (SSI), bowel obstruction, faecal fistula, paralytic ileus, length of hospital stay (LOS) and mortality were the evaluated outcome parameters for the meta-analysis. Seventeen studies reporting a total number of 4,255 patients who underwent appendicectomy for complicated appendicitis with (n=1,580) or without (n=2,657) drain were included. There was no significant difference between the two groups regarding abdominal collection (odds ratio (OR)=1.41, P=0.13). No-drain group was superior to the drain group regarding SSI (OR=1.93, P=0.0001), faecal fistula (OR=4.76, P=0.03), intestinal obstruction (OR=2.40, P=0.04) and paralytic ileus (OR=2.07, P=0.01). There was a difference regarding mortality rate between the two groups (3.4% in the drain group vs 0.5% in the no-drain group, risk difference (RD)=0.01, 95% CI (-0.01, 0.04), P=0.36). In conclusion, this metaanalysis has shown that drains have no effect on the development of intra-abdominal collections in complicated appendicitis, but it can significantly increase the risk of postoperative complications such as fistula, surgical site infection (SSI), bowel obstruction, ileus and length of hospital stay.

Development of a nomogram for predicting acute pain among patients after abdominal surgery: A prospective observational study

“…Reasons may be that its use was not only associated with longer operative time but also with a rise in pain sensitivity following the use of remifentanil during surgery (Ren et al, 2023). Drainage tubes are routinely placed in most procedures to prevent fluid collection and timely find complications after surgery (Abu et al, 2022). This study found that drain is one of the predictors of pain during the early post-operative period.…”

Controversies and Future Directions in Management of Acute Appendicitis: An Updated Comprehensive Review

“…This obstruction can result from the drain’s mechanical presence (foreign object) or through the potential introduction of extra-abdominal bacteria, and thus, infection and scarring [ 67 ]. Furthermore, Cheng et al observed that routine intra-abdominal drain placement after open emergency appendectomy for complicated appendicitis was not associated with reduced risk of intraperitoneal abscess formation [ 68 ]. In another systematic review and meta-analysis of 17 studies consisting of 4255 patients with complicated appendicitis, 1580 underwent abdominal drainage, while 2657 did not [ 69 ].…”

Laparoscopic Appendectomy in Complicated Appendicitis: A Narrative Review

“…"A meta-analysis by Abu et al evaluated drain insertion after appendectomy for complicated appendicitis, and they concluded that drain insertion does not increase the risk of intraabdominal abscess formation, but it significantly increases the risk of surgical site infection, length of hospital stays and bowel obstruction" [43].…”