Cochrane: Appendicitis
refers to inflammation of the appendix. Appendectomy, the surgical
removal of the appendix, is performed primarily in patients who have acute appendicitis. Patients undergoing an appendectomy for complicated appendicitis, which is defined as gangrenous (soft-tissue death) or perforated (burst) appendicitis, are more likely to suffer from postoperative
complications. The routine placement of a surgical drain to prevent
intra-peritoneal abscess (a localised collection of pus in the abdomen
or pelvis) after an appendectomy for complicated appendicitis is controversial.
This systematic review included five randomised controlled trials involving a total of 453 participants. All the five trials compared drain use versus no drain use in cases of emergency open appendectomy (removal of the appendix by laparotomy) for complicated appendicitis. All trials had a high risk of bias (suggesting the possibility of over- or under-estimating the benefits or harms). There was no difference in the rate of intra-peritoneal abscess between drain use and no drain use. The hospital stay was longer (about two days - an 34.4% increase on an 'average' stay) in the drain group than in the no drain group.
The quality of the current trial evidence is very low. It is not clear whether routine drain use has any effect on preventing intra-peritoneal abscess after open appendectomy for complicated appendicitis. Routine drain use after an emergency open appendectomy may delay hospital discharge for patients with complicated appendicitis.
This systematic review included five randomised controlled trials involving a total of 453 participants. All the five trials compared drain use versus no drain use in cases of emergency open appendectomy (removal of the appendix by laparotomy) for complicated appendicitis. All trials had a high risk of bias (suggesting the possibility of over- or under-estimating the benefits or harms). There was no difference in the rate of intra-peritoneal abscess between drain use and no drain use. The hospital stay was longer (about two days - an 34.4% increase on an 'average' stay) in the drain group than in the no drain group.
The quality of the current trial evidence is very low. It is not clear whether routine drain use has any effect on preventing intra-peritoneal abscess after open appendectomy for complicated appendicitis. Routine drain use after an emergency open appendectomy may delay hospital discharge for patients with complicated appendicitis.