Role of Drains in Laparoscopic Appendectomy for Complicated Appendicitis at a Busy County Hospital

Abstract

Laparoscopic appendectomy (LA) has become the treatment of choice for acute appendicitis with equal or better outcomes than traditional open appendectomy (OA). LA in patients with a gangrenous or perforated appendicitis carries increased rate of pelvic abscess formation when compared with OA. We hypothesized routine placement of pelvic drains in gangrenous or perforated appendicitis decreases pelvic abscess formation after LA. Three hundred thirty-one patients undergoing LA between January 2007 and June 2011 were reviewed. Patients with perforated or gangrenous appendicitis were included. Group I had a Jackson-Pratt (JP) drain(s) placed and Group II had no JP drain. Data included patient demographics, emergency department laboratory values and vital signs, and computed axial tomography scan findings, intra-abdominal or pelvic abscess postoperatively, interventional radiology drainage, and length of stay. Clinic follow-up notes were reviewed. One hundred forty-eight patients were identified. Forty-three patients had placement of JP drains (Group I) and 105 patients had no JP drain (Group II). Three patients (three of 43 [6%]) in Group I developed pelvic abscess and 21 of 105 (20%) patients in Group II developed pelvic abscesses requiring subsequent drainage. This was statistically significant. Patient demographics, temperature, and mean white blood count before surgery were similar. Presurgery computed tomography (CT) with appendicolith and CT with abscess were more prevalent in Group I. The use of JP drainage in patients with perforated or gangrenous appendicitis during LA has decreased rates of pelvic abscess. This was demonstrated despite the drain group having appendicolith or abscess on preoperative CT.

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

“…There are a few reports, which support the use of prophylactic abdominal drainage after appendectomy in the literature (11,12). However, there are more studies published indicating that prophylactic drainage is not required after open or laparoscopic appendectomy in both adults and children (13)(14)(15)(16)(17)(18)(19).…”

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

“…A Japanese study [ 7 ] showed that routine drainage did not confer advantages in terms of postoperative outcome or length of hospital stay in pediatric patients with complicated appendicitis. By contrast, both Pakula et al [ 8 ] and Beek et al [ 9 ] concluded that the use of a drain decreased the risk of intra-abdominal abscess formation.…”

Analysis of Outcomes Using Intraoperative Irrigation and Drainage for Complicated Appendicitis

“…However, Beek et al, in a retrospective study focusing on the effectiveness of peritoneal drainage for patients with perforated appendicitis having surgery, demonstrate a reduction in the overall complication rate for patients receiving intraoperative peritoneal drainage for perforated appendicitis [7]. Similarly, Pakula et al in a retrospective study demonstrated that the use of Jackson-Pratt (JP) drains in patients with perforated or gangrenous appendicitis during laparoscopic appendectomy had decreased rates of pelvic abscess [8]. Irrigation and Drainage for Appendicitis J Curr Surg.…”