Abdominal drainage to prevent intraperitoneal abscess after appendectomy for complicated appendicitis

Area of Science:

• Surgery
• Gastroenterology
• Evidence-Based Medicine

Background:

• Appendectomy is standard for acute appendicitis.
• Complicated appendicitis (gangrenous or perforated) carries higher risks of postoperative complications.
• The role of routine abdominal drainage in these cases remains controversial.

Purpose of the Study:

• To assess the benefits and harms of abdominal drainage after appendectomy for complicated appendicitis.
• To compare different types of surgical drains and optimal removal times.
• To evaluate the impact on intraperitoneal abscess formation.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs) and quasi-RCTs.
• Included studies compared drain versus no drain, open versus closed drains, or drain removal schedules.
• Outcomes included intraperitoneal abscess, wound infection, morbidity, mortality, and hospital stay.

Main Results:

• Very low-certainty evidence suggests drainage does not significantly reduce intraperitoneal abscess or wound infection.
• Moderate-certainty evidence indicates drainage may increase 30-day mortality risk (Peto OR 4.88).
• Drainage may increase hospital stay, but evidence is very uncertain.

Conclusions:

• Current evidence is highly uncertain regarding the benefits of abdominal drainage for complicated appendicitis.
• No clinical improvement was demonstrated with drainage use.
• Larger studies are needed to clarify the effects on mortality and other outcomes.