Prophylactic abdominal drainage following appendectomy for complicated appendicitis: A meta-analysis

Area of Science:

• Surgical Oncology
• Gastrointestinal Surgery
• Evidence-Based Medicine

Background:

• The utility of prophylactic abdominal drainage (AD) following appendectomy for complicated appendicitis (CA) remains unclear in both adult and pediatric populations.
• This study addresses the safety and effectiveness of prophylactic AD in CA patients.

Purpose of the Study:

• To conduct a meta-analysis evaluating the impact of prophylactic AD on postoperative complications in patients with CA.
• To determine the safety and effectiveness of prophylactic AD in this patient group.

Main Methods:

• A systematic literature search was performed across major databases (PubMed, Science Direct, Web of Science, Cochrane Library, Embase) up to August 1, 2022.
• Primary outcomes included overall postoperative complications, intra-abdominal abscess (IAA), wound infection (WI), and postoperative ileus (PI).
• Meta-analysis was conducted using STATA V. 16.0A.

Main Results:

• The meta-analysis included 15 studies with 5,123 patients (1,796 with AD, 3,327 without).
• Patients receiving AD experienced longer hospital stays, higher overall complication rates, and increased incidences of WI and PI.
• No significant difference in IAA incidence was observed between groups. Subgroup analysis indicated higher overall complications in adults with AD, and higher WI and PI in children with AD.

Conclusions:

• Prophylactic AD following appendectomy for CA offers no discernible benefit and is associated with an increased risk of complications, especially in pediatric patients.
• Current evidence does not support the routine use of prophylactic AD in patients undergoing appendectomy for CA.