Time to Avoid Prophylactic Intra-abdominal Drainage in Acute Complicated Appendicitis: An Updated Systematic Review...

Area of Science:

• Surgical Outcomes
• Gastroenterology
• Evidence-Based Medicine

Background:

• Appendicectomy is a common surgical procedure.
• Complicated appendicitis often involves concerns about post-operative complications.
• The use of abdominal drains is a debated practice in appendicectomy.

Purpose of the Study:

• To systematically review and meta-analyze clinical outcomes comparing drain versus no-drain groups in appendicectomy for complicated appendicitis.
• To assess the impact of abdominal drains on post-operative complications and hospital stay.
• To evaluate the safety of drain use, particularly in pediatric patients.

Main Methods:

• Systematic literature search across multiple databases (MEDLINE, PubMed, ScienceDirect, Embase, Scopus, ClinicalTrials.gov).
• Inclusion of 21 studies comprising 4,930 patients (1,809 with drains, 3,121 without).
• Meta-analysis to compare clinical outcomes between drain and no-drain groups.

Main Results:

• No significant difference in post-operative abdominal collection or mortality between groups.
• The no-drain group showed significantly lower rates of surgical site infection, faecal fistulae, intestinal obstruction, and paralytic ileus.
• Patients without drains experienced a shorter hospital stay.
• Pediatric subgroup analysis indicated an increased risk of abdominal collection in the drain group.

Conclusions:

• Routine use of abdominal drains in appendicectomy for complicated appendicitis is associated with increased post-operative complications.
• Omitting drains may lead to better patient outcomes, including reduced infection rates and shorter hospitalizations.
• Abdominal drains may increase the risk of abdominal collection in pediatric patients undergoing appendicectomy for complicated appendicitis.