Drain placement in paediatric complicated appendicitis: a systematic review and meta-analysis

Area of Science:

• Pediatric Surgery
• Surgical Outcomes
• Evidence-Based Medicine

Background:

• Children with complicated appendicitis face increased post-operative morbidity.
• The use of intra-peritoneal drains to prevent complications is debated.

Approach:

• Systematic review following PRISMA guidelines.
• Searched Cochrane, MEDLINE, and Web of Science databases (inception–November 2022).
• Included 16 studies with 5108 children (≤18 years) comparing drain vs. no drain placement.

Key Points:

• Drain placement significantly increased intra-peritoneal abscess risk (OR 1.61).
• No significant difference in wound infection rates was observed.
• Drain group experienced significantly longer hospital stays (mean difference 2.02 days).

Conclusions:

• Prophylactic drain placement does not prevent intra-peritoneal abscess in pediatric complicated appendicitis.
• Evidence quality is low, but findings suggest drains may be detrimental.
• Further research is needed to clarify optimal management strategies.