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Abdominal Drainage After Laparoscopic Appendectomy in Children: An Endless Controversy?
B Aneiros Castro1, I Cano1, A García1
11 Department of Pediatric Surgery, Hospital 12 de Octubre, Madrid, Spain.
Insights
Routine prophylactic abdominal drains after pediatric laparoscopic appendectomy for perforated appendicitis do not prevent complications. Drains were associated with increased antibiotic use, longer fasting, and extended hospital stays.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Infectious Disease
Background:
- The use of prophylactic abdominal drains following laparoscopic appendectomy for perforated appendicitis in children remains a subject of debate.
- While historically drains were thought to offer benefits, recent evidence suggests potential complications without clear advantages.
Purpose of the Study:
- To evaluate the efficacy of prophylactic abdominal drains in preventing postoperative complications after laparoscopic appendectomy for perforated appendicitis in pediatric patients.
- To identify any potential negative outcomes associated with drain placement in this patient population.
Main Methods:
- A retrospective review of 192 pediatric patients who underwent laparoscopic appendectomy for perforated appendicitis between January 2000 and December 2013.
- Patients were divided into two groups: those with prophylactic drains (n=117) and those without (n=75).
- Demographic data, operative findings, and postoperative outcomes were analyzed for both groups.
Main Results:
- No statistically significant differences were found in the rates of intra-abdominal abscess, wound infection, or bowel obstruction between the drained and undrained groups.
- The group with drains showed a statistically significant increase in the requirement for antibiotics and analgesics.
- Patients with drains also experienced longer fasting times, increased operative times, and extended hospital stays.
Conclusions:
- Prophylactic abdominal drainage after laparoscopic appendectomy for perforated appendicitis in children does not appear to prevent postoperative complications.
- The use of drains may be associated with adverse outcomes, including increased resource utilization.
- Further prospective randomized studies are needed to definitively confirm these findings.
Background:
Routine prophylactic abdominal drains after laparoscopic appendectomy for perforated appendicitis in children are still controversial. Throughout the history of surgery, potential benefits of the abdominal drains have been described. However, in recent studies, no benefits were observed and serious complications have been reported.
Methods:
From January 2000 to December 2013, all charts of the pediatric patients who underwent laparoscopic appendectomy in our tertiary center were revised. The data from 1736 appendectomies were analyzed. We only included those patients with perforated appendicitis treated with early appendectomy (n = 192). Prophylactic drains were established according to the surgeon's preference. The sample was divided into two groups, those with drain (n = 117) and those without drain (n = 75). Demographics, operative findings, and postoperative outcomes were analyzed in both groups.
Results:
Of all patients, 121 were male and 71 were female with a mean age of 7.77 ± 3.4 years. There were not statistically significant differences between the groups in gender (p = 0.82) and mean age (p = 0.31). There were no statistically significant differences between the two groups in the rate of intra-abdominal abscess, wound infection, and bowel obstruction. However, the drainage group has been statistically associated with an increased requirement of antibiotic and analgesic medication, fasting time, operative time, and length of hospital stay.
Conclusion:
The prophylactic use of abdominal drainage after laparoscopic appendectomy for perforated appendicitis in children does not prevent postoperative complications and may be associated with negative outcomes. Prospective randomized studies will be necessary to verify this question.
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