Intra-abdominal Abscess After Appendectomy—Are Drains Necessary in All Patients?

Svetanoff, Wendy Jo; Talukdar, Neal; Dekonenko, Charlene; Dorman, Robert M.; Osuchukwu, Obiyo; Fraser, Jason D.; Oyetunji, Tolulope A.; Peter, Shawn D. St.

doi:10.1016/j.jss.2020.05.016

Cited by 11 publications

(6 citation statements)

References 10 publications

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“…A flowchart of the study selection can be found in Figure 1 . Study designs of the three included studies were one prospective cohort study and two historical cohort studies ( 6 , 11 , 12 ). Risk of bias was assessed as moderate in the prospective cohort and serious in both historical cohort studies.…”

Section: Resultsmentioning

confidence: 99%

“…In the prospective cohort study reporting on 30 children with PAA, the implementation of a treatment algorithm for PAA was evaluated ( 12 ). This algorithm recommends non-invasive treatment with antibiotics for PAA smaller than 20 cm 2 (i.e., diameter <2,5 cm) and aspiration and/or percutaneous drainage for PAA larger than 20 cm 2 .…”

Section: Resultsmentioning

confidence: 99%

“…Thus far, only one small prospective cohort study and few historical cohort studies have been published. These studies report that treatment success rates range between 69 and 100% after non-invasive treatment, between 0 and 100% after percutaneous drainage, and between 36 and 100% after surgical drainage ( 4 – 6 , 11 , 12 , 14 – 17 ). Our study reports comparable results, since non-invasive treatment was successful in 21 of 29 patients (72%) and invasive treatment in 27 of 41 patients (66%).…”

Section: Discussionmentioning

confidence: 99%

“…The treatment of PAA smaller than 3 cm is less subject of debate in children. Although historically, especially in adults, invasive treatment procedures for PAA were preferred, several more recent studies have reported promising results of non-operative treatment of small PAA with treatment successes ranging between 84 and 100% ( 6 , 12 , 18 – 20 ). This is in line with the results of our multicenter cohort, in which all patients with PAA smaller than 3 cm were successfully treated with a non-invasive treatment strategy.…”

Section: Discussionmentioning

confidence: 99%

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The Management of Post-appendectomy Abscess in Children; A Historical Cohort Study and Update of the Literature

et al. 2022

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IntroductionRecent studies have shown that specific cases of post-appendectomy abscess (PAA) in children could be treated conservatively. However, due to the lack of high-quality evidence, choice of treatment still depends on preferences of the treating surgeon, leading to heterogeneity in clinical practice. Therefore, we aimed to provide an update of recent literature on the management of PAA in children and subsequently evaluate the outcomes of a large multicenter cohort of children treated for PAA.MethodsA literature search was performed in Pubmed and Embase, selecting all randomized controlled trials, prospective and retrospective cohort studies, and case series published from 2014 and onward and reporting on children (<18 years) treated for a PAA. Subsequently, a historical cohort study was performed, including all children (<18 years) treated for a radiologically confirmed PAA between 2014 and 2021 in a tertiary referral center and two large peripheral centers. Medical charts were reviewed to compare non-invasive (i.e., antibiotics) and invasive (i.e., drainage procedures) treatment strategies. Primary outcome was the success rate of treatment, defined as no need for further interventions related to PAA or its complications.ResultsThe search yielded 1,991 articles, of which three were included. Treatment success ranged between 69–88% and 56–100% for non-invasive and invasive strategies, respectively. Our multicenter cohort study included 70 children with a PAA, of which 29 (41%) were treated non-invasively and 41 (59%) invasively. In the non-invasive group, treatment was effective in 21 patients (72%) compared to 25 patients (61%) in the invasive group. Non-invasive treatment was effective in 100% of unifocal small (<3 cm) and 80% of unifocal medium size PAA (3–6 cm), but not effective for multiple abscesses.ConclusionNon-invasive treatment of especially unifocal small and medium size (<6 cm) PAA in children seems to be safe and effective. Based on these results, a standardized treatment protocol was developed. Prospective validation of this step-up approach-based treatment protocol is recommended.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Management of Post-appendectomy Abscess in Children; A Historical Cohort Study and Update of the Literature

et al. 2022

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“…The drainage of abdominal abscesses may not always be necessary; for example, small postoperative abscesses (less than 2 cm 3 ) can be managed without intervention or drain after appendectomy [33]. In addition, in diverticular disease, small abscesses can be treated with antibiotics, but larger abscesses of 3-5 cm in diameter should be drained percutaneously [34].…”

Section: Therapeutic Usementioning

confidence: 99%

The Role of Abdominal Drain Cultures in Managing Abdominal Infections

et al. 2022

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Intra-abdominal infections (IAI) are common in hospitalized patients, both in and outside of the intensive care unit. Management principles include antimicrobial therapy and source control. Typically, these infections are polymicrobial, and intra-operative samples will guide the targeted antimicrobial therapy. Although the use of prophylactic abdominal drains in patients undergoing abdominal surgery is decreasing, the use of drains to treat IAI, both in surgical and non-surgical strategies for abdominal infection, is increasing. In this context, samples from abdominal drains are often used to assist in antimicrobial decision making. In this narrative review, we provide an overview of the current role of abdominal drains in surgery, discuss the importance of biofilm formation in abdominal drains and the mechanisms involved, and review the clinical data on the use of sampling these drains for diagnostic purposes. We conclude that biofilm formation and the colonization of abdominal drains is common, which precludes the use of abdominal fluid to reliably diagnose IAI and identify the pathogens involved. We recommend limiting the use of drains and, when present, avoiding routine microbiological sampling.

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Appendicitis

Briggs

Peter

2022

Fundamentals of Pediatric Surgery

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Intra-abdominal Abscess After Appendectomy—Are Drains Necessary in All Patients?

Cited by 11 publications

References 10 publications

The Management of Post-appendectomy Abscess in Children; A Historical Cohort Study and Update of the Literature

The Management of Post-appendectomy Abscess in Children; A Historical Cohort Study and Update of the Literature

The Role of Abdominal Drain Cultures in Managing Abdominal Infections

Appendicitis

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