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The utility of intraperitoneal drain placement after laparoscopic appendectomy for perforated appendicitis in
Jasim Alabbad1,2, Hadeel Alhamly3, Abdulaziz Alrubaiaan3
1Mubarak Al-Kabeer Hospital, Jabriya, Kuwait. jasim.alabbad@ku.edu.kw.
Insights
Intraperitoneal drains after laparoscopic appendectomy for perforated appendicitis do not reduce abscess formation. This practice may increase length of hospital stay without significant benefits.
Area of Science:
- Surgical outcomes
- Gastrointestinal surgery
- Infectious disease
Background:
- Perforated appendicitis frequently leads to postoperative intraperitoneal abscess.
- Intraperitoneal drains are hypothesized to mitigate this risk during appendectomy.
Purpose of the Study:
- To evaluate the efficacy of intraperitoneal drain placement in preventing postoperative intraperitoneal abscess after laparoscopic appendectomy for perforated appendicitis.
Main Methods:
- Retrospective analysis of 511 patients (age ≥7) undergoing laparoscopic appendectomy for perforated appendicitis (2018-2022).
- Comparison of outcomes between patients with and without intraoperative intraperitoneal drains.
- Primary outcome: postoperative intraperitoneal abscess. Secondary outcomes: complications, SSI, LOS, readmission.
Main Results:
- No significant difference in intraperitoneal abscess rates between drained (6.5%) and undrained (5.4%) groups (p=0.707).
- Patients with drains experienced a longer length of stay (LOS) (p<0.001).
- No significant differences in overall complications, superficial surgical site infection (SSI), or readmission rates were observed.
Conclusions:
- Intraperitoneal drain placement offers no discernible benefit in reducing abscess formation post-laparoscopic appendectomy for perforated appendicitis.
- The use of drains may be associated with an increased length of hospital stay.
Background:
Perforated appendicitis is associated with postoperative development of intraperitoneal abscess. Intraperitoneal drain placement during appendectomy is thought to reduce the risk of developing postoperative intraperitoneal abscess. The aim of this study was to determine whether intraperitoneal drainage could reduce the incidence of intraperitoneal abscess formation after laparoscopic appendectomy for perforated appendicitis.
Methods:
This is a retrospective study of all patients (aged 7 and above) who were diagnosed with perforated appendicitis and subsequently underwent laparoscopic appendectomy between January 2018 and December 2022 at two government hospitals in the state of Kuwait. Demographic, clinical, and perioperative characteristics were compared between patients who underwent intraoperative intraperitoneal drain placement and those who did not. The primary outcome was the development of postoperative intraperitoneal abscess. Secondary outcomes included overall postoperative complications, superficial surgical site infection (SSI), length of stay (LOS), readmission and postoperative percutaneous drainage.
Results:
A total of 511 patients met the inclusion criteria between 2018 and 2022. Of these, 307 (60.1%) underwent intraoperative intraperitoneal drain placement. Patients with and without drains were similar regarding age, sex, and Charlson Comorbidity Index (CCI) (Table 1). The overall rate of postoperative intraperitoneal abscess was 6.1%. Postoperatively, there was no difference in postoperative intraperitoneal abscess formation between patients who underwent intraperitoneal drain placement and those who did not (6.5% vs. 5.4%, p = 0.707). Patients with intraperitoneal drains had a longer LOS (4 [4, 6] vs. 3 [2, 5] days, p < 0.001). There was no difference in the overall complication (18.6% vs. 12.3%, p = 0.065), superficial SSI (2.9% vs. 2.5%, p = 0.791) or readmission rate (4.9% vs. 4.4%, p = 0.835).
Conclusions:
Following laparoscopic appendectomy for perforated appendicitis, intraperitoneal drain placement appears to confer no additional benefit and may prolong hospital stay.
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