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Abdominal drainage following appendectomy and cholecystectomy
Annals of Surgery
|June 1, 1978
Summary
Penrose drains in appendectomy for gangrenous or perforated appendicitis significantly increase incisional and intra-abdominal infection rates. Avoiding drains reduces sepsis risk and abscess formation in these severe cases.
Area of Science:
- Surgical Infections
- Abdominal Surgery
- Infectious Disease
Background:
- Post-operative sepsis remains a significant concern following abdominal surgery.
- The role of surgical drains in preventing or contributing to peritoneal and incisional infections requires further clarification.
- Appendectomy and cholecystectomy are common emergency procedures with varying infection risks.
Purpose of the Study:
- To prospectively evaluate the impact of Penrose drains on post-operative sepsis development.
- To compare infection rates in patients undergoing appendectomy or cholecystectomy with and without peritoneal drainage.
- To identify specific surgical conditions where drain use may influence infection outcomes.
Main Methods:
- Prospective study of patients undergoing emergency appendectomy or urgent cholecystectomy.
- Randomized assignment to use or not use a Penrose drain for peritoneal drainage.
- Recording severity of original peritoneal infection and collecting aerobic/anaerobic cultures.
Main Results:
- No significant difference in infection rates for simple/suppurative appendicitis or acute cholecystitis with or without drains.
- For gangrenous/perforative appendicitis, drain use was associated with significantly higher incisional (43% vs 29%) and intra-abdominal (45% vs 13%) infection rates (p < 0.001).
- Intra-abdominal abscesses were more likely to drain via the incision than the Penrose drain; drain use correlated with hospital pathogens in less severe cases, while mixed flora predominated in severe appendicitis.
Conclusions:
- Penrose drains do not benefit, and may significantly harm, patients undergoing appendectomy for gangrenous or perforated appendicitis by increasing infection rates.
- Drainage strategies should be carefully considered based on the severity of appendicitis to minimize post-operative sepsis.
- Avoiding drains in severe appendicitis cases is recommended to reduce the incidence of incisional and intra-abdominal infections.