The Role of Drains in Complicated Appendicectomy in Adults: A Narrative Review

Drain placement after appendicectomy for complicated appendicitis remains a subject of ongoing debate. Although drains were traditionally used to prevent intra-abdominal abscesses, more recent evidence indicates limited benefit and potential harm. Substantial international variation persists, and there is no clear consensus regarding indications and clinical benefit. In light of this, we conducted a narrative review of the literature from 2010 to 2025 using MEDLINE, Embase, and the Cochrane Library. Randomised controlled trials, observational studies, systematic reviews, and guidelines evaluating drain use after appendicectomy in complicated appendicitis were included. Evidence was synthesised regarding postoperative intra-abdominal abscess (IAA), wound complications, length of stay, and need for reintervention. Most contemporary studies demonstrate that routine drainage does not reduce postoperative IAA and is associated with increased wound complications, pain, and postoperative hospital length of stay (LOS). Major guidelines generally recommend against routine drainage, favouring irrigation and adequate source control instead. Routine drain placement after perforated appendicitis is not supported by current evidence. Selective use may be considered in limited situations where optimal source control is uncertain. Further high-quality randomised controlled trials are needed to clarify indications and identify subgroups that may benefit.