Is peritoneal drainage necessary after laparoscopic appendectomy for complicated acute appendicitis in children?

This study aimed to evaluate the efficacy of peritoneal drainage following laparoscopic appendectomy for complicated acute appendicitis in pediatric patients.

This prospective randomized, parallel-group superiority trial with 1:1 allocation at a single tertiary pediatric center included 210 children (≤18 years) with complicated appendicitis (appendicular mass, abscess, gangrene, perforation, or free peritoneal pus) who underwent laparoscopic appendectomy. Patients were randomly assigned to 2 groups (105 each): Group A (drainage) and Group B (no drainage). Standardized operative and postoperative protocols were applied. The primary outcome was overall surgical-site infection (SSI). Pre-specified secondary outcomes included intra-abdominal infection (IAI, a subtype of SSI), wound infection, postoperative ileus, time to return of bowel function, duration of antibiotic therapy, length of hospital stay, and 30-day hospital cost. Robust regression methods including penalized likelihood and quantile regression were used for adjusted analyses.

Baseline characteristics were comparable. Overall surgical-site infection (primary endpoint) did not differ significantly between the drainage and no-drainage groups (20.0% vs. 27.6%; p = 0.312). In exploratory secondary analyses, drainage was associated with a lower rate of intra-abdominal infection (6.67% vs. 15.24%; p = 0.046), similar wound infection rates (13.33% vs. 12.38%; p = 0.836), fewer postoperative ileus events (4.76% vs. 13.33%; p = 0.050), earlier return of bowel function (median 13.9 h [IQR 11.0-16.5] vs. 17.3 h [14.0-20.8]; p < 0.001), shorter antibiotic duration, reduced length of stay, and lower 30-day hospital costs. These secondary findings were not α-adjusted and are interpreted as hypothesis-generating.

Peritoneal drainage did not significantly reduce the primary endpoint of overall surgical-site infection. However, secondary analyses suggested potential benefits (including fewer intra-abdominal infections, faster recovery, and lower short-term costs) that should be considered exploratory. Selective drainage may be beneficial in this setting, but confirmation in larger multicenter pediatric trials is needed before routine adoption.