Peritoneal lavage versus drainage for perforated appendicitis in children

Abstract

A total of 231 children with acute appendicitis were treated at our hospitals during the 10 years between 1984 and 1993, 53 of whom had a perforated appendix. These 53 patients were randomly assigned to two groups at the time of surgery according to the different procedures performed. Thus, 29 children were managed by appendectomy followed by peritoneal lavage using a large amount of saline, and intravenous antibiotic therapy consisting of aminoglycoside and cephem (lavage group), while the other 24 children were treated by appendectomy with silicon tube drainage and the same systemic antibiotic therapy (drainage group). The mean length of hospitalization, and the mean durations of fever and the need for fasting after laparotomy in the lavage group were significantly less than those in the drainage group: 10.1 versus 18.8 days, 2.8 versus 7.7 days, and 1.8 versus 3.5 days, respectively. The operation wounds healed well in the lavage group due to the fact that there was no drain. Wound infections occurred in two children from the lavage group and six from the drainage group. Intra-abdominal abscesses occurred in two children from the drainage group. Accordingly, peritoneal lavage appears to be superior to intraperitoneal tube drainage for the management of perforated appendicitis in children.

Prevention of infectious complications after laparoscopic appendectomy for complicated acute appendicitis—the role of routine abdominal drainage

“…Nevertheless, the role of this practice remains an ongoing matter of debate [17][18][19][20][21][22][23][24][25]. Routine drainage of the abdominal cavity after various types of surgical interventions has been a robust dogma in abdominal surgery for many decades.…”

Meta-analysis of peritoneal lavage in appendicectomy

“…Three of the included studies were RCTs; the remainder were retrospective cohort studies. Four studies included analysis only of the paediatric population, two of which were performed entirely using open surgery. The age of the population was poorly reported throughout.…”

“…The age of the population was poorly reported throughout. There was a high degree of variation between pathological findings at surgery, with some studies , analysing the outcomes only of patients with complex appendicitis (perforation, gangrene, localized abscess) , whereas the remaining studies included patients with simple appendicitis (inflammation in the appendix alone). In some studies drains were never used as part of local institutional policy, whereas drains were used in the remaining studies at the discretion of the operating surgeon.…”

“…Notably, the methods of lavage varied between studies. In three studies , copious lavage throughout all four quadrants was employed, whereas in others , the decision between four‐quadrant and local lavage was made at the discretion of the surgeon. In no study was the number of patients undergoing four‐quadrant or local lavage reported.…”

Receiver-Operating Characteristic Analysis of Leukocyte Counts and Serum C-Reactive Protein Levels in Children with Advanced Appendicitis

“…Toki et al reported that peritoneal lavage with 1 000-8 000 ml of saline was better than tube drainage for the management of perforated appendicitis in children. 6 Thus, we are attempting to minimize the use of tube drainage in consideration of their results and our recent experience. We also recommend that if an initial physical examination and a high CRP value indicate acute appendicitis in a child, further investigations should be done, and appropriate management initiated as early as possible.…”