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Prevention of infectious complications after laparoscopic appendectomy for complicated acute appendicitis—the role of routine abdominal drainage

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Abstract

Purpose

Complicated acute appendicitis is still associated with an increased morbidity. If laparoscopy has been accepted as a valid approach, some questions remain concerning intra-abdominal abscess formation. Routine prophylactic drainage of the abdomen has been proposed. However, this practice remains a matter of debate, poorly validated in the literature. With the present study, we investigated the impact of drainage in laparoscopic appendectomy for complicated appendicitis.

Method

This is a case match study of consecutive patients operated on by laparoscopy in a single institution. One hundred and thirty patients operated for complicated appendicitis (local peritonitis without perforation, with perforation, or with periappendicular abscess) with prophylactic intraperitoneal drainage were matched one by one to 130 patients operated without drainage. Uncomplicated appendicitis and generalized peritonitis were excluded. Primary endpoint was surgical complications and secondary endpoints were transit recovery time and length of hospital stay.

Results

Patients without drain had significantly less overall complications (7.7% vs. 18.5%, p = 0.01). Moreover, the absence of drainage was of significant benefit for transit recovery time (2.5 vs. 3.5 days, p = 0.0068) and length of hospital stay (4.2 vs. 7.3 days, p < 0.0001).

Conclusion

No benefits were observed for prophylactic drainage of the abdominal cavity during emergency laparoscopic treatment of complicated appendicitis. For this reason, this practice may be abandoned.

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References

  1. Cueto J, Dallemagne B, Vázquez-Frias JA, Gomez S, Delgado F, Trullenque L, Fajardo R, Valencia S, Poggi L, Ballí J, Diaz J, González R, Mansur JH, Franklin ME (2006) Morbidity of laparoscopic surgery for complicated appendicitis: an international study. Surg Endosc 20(5):717–720

    Article  CAS  PubMed  Google Scholar 

  2. Ming PC, Yan TY, Tat LH (2009) Risk factors of postoperative infections in adults with complicated appendicitis. Surg Laparosc Endosc Percutan Tech 19(3):244–248

    Article  PubMed  Google Scholar 

  3. Garg CP, Vaidya BB, Chengalath MM (2009) Efficacy of laparoscopy in complicated appendicitis. Int J Surg 7(3):250–252

    Article  PubMed  Google Scholar 

  4. Faiz O, Clark J, Brown T, Bottle A, Antoniou A, Farrands P, Darzi A, Aylin P (2008) Traditional and laparoscopic appendectomy in adults: outcomes in English NHS hospitals between 1996 and 2006. Ann Surg 248(5):800–806

    Article  PubMed  Google Scholar 

  5. Van Hove C, Hardiman K, Diggs B, Deveney C, Sheppard B (2008) Demographic and socioeconomic trends in the use of laparoscopic appendectomy from 1997 to 2003. Am J Surg 195(5):580–583, discussion 583–584

    Article  PubMed  Google Scholar 

  6. Paterson HM, Qadan M, de Luca SM, Nixon SJ, Paterson-Brown S (2008) Changing trends in surgery for acute appendicitis. Br J Surg 95(3):363–368

    Article  CAS  PubMed  Google Scholar 

  7. Yau KK, Siu WT, Tang CN, Yang GP, Li MK (2007) Laparoscopic versus open appendectomy for complicated appendicitis. J Am Coll Surg 205(1):60–65

    Article  PubMed  Google Scholar 

  8. Moberg AC, Berndsen F, Palmquist I, Petersson U, Resch T, Montgomery A (2005) Randomized clinical trial of laparoscopic versus open appendicectomy for confirmed appendicitis. Br J Surg 92(3):298–304

    Article  PubMed  Google Scholar 

  9. Katkhouda N, Mason RJ, Towfigh S, Gevorgyan A, Essani R (2005) Laparoscopic versus open appendectomy: a prospective randomized double-blind study. Ann Surg 242(3):439–448, discussion 448–450

    PubMed  Google Scholar 

  10. Aziz O, Athanasiou T, Tekkis PP, Purkayastha S, Haddow J, Malinovski V, Paraskeva P, Darzi A (2006) Laparoscopic versus open appendectomy in children: a meta-analysis. Ann Surg 243(1):17–27

    Article  PubMed  Google Scholar 

  11. Lin HF, Wu JM, Tseng LM, Chen KH, Huang SH, Lai IR (2006) Laparoscopic versus open appendectomy for perforated appendicitis. J Gastrointest Surg 10(6):906–910

    Article  PubMed  Google Scholar 

  12. Fukami Y, Hasegawa H, Sakamoto E, Komatsu S, Hiromatsu T (2007) Value of laparoscopic appendectomy in perforated appendicitis. World J Surg 31(1):93–97

    Article  PubMed  Google Scholar 

  13. Harrell AG, Lincourt AE, Novitsky YW, Rosen MJ, Kuwada TS, Kercher KW, Sing RF, Heniford BT (2006) Advantages of laparoscopic appendectomy in the elderly. Am Surg 72(6):474–480

    PubMed  Google Scholar 

  14. Sauerland S, Lefering R, Neugebauer EA (2002) Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev 1:CD001546

    PubMed  Google Scholar 

  15. Kehagias I, Karamanakos SN, Panagiotopoulos S, Panagopoulos K, Kalfarentzos F (2008) Laparoscopic versus open appendectomy: which way to go? World J Gastroenterol 14(31):4909–4914

    Article  PubMed  Google Scholar 

  16. Katsuno G, Nagakari K, Yoshikawa S, Sugiyama K, Fukunaga M (2009) Laparoscopic appendectomy for complicated appendicitis: a comparison with open appendectomy. World J Surg 33(2):208–214

    Article  PubMed  Google Scholar 

  17. Tander B, Pektas O, Bulut M (2003) The utility of peritoneal drains in children with uncomplicated perforated appendicitis. Pediatr Surg Int 19:548–550

    Article  CAS  PubMed  Google Scholar 

  18. Stone HH, Hooper CA, Millikan WJ (1978) Abdominal drainage following appendectomy and cholecystectomy. Ann Surg 187:606–612

    Article  CAS  PubMed  Google Scholar 

  19. Magarey CJ, Chant ABD, Rickford CRK (1971) Peritoneal drainage and systemic antibiotics after appendectomy. Lancet 2:179–182

    Article  CAS  PubMed  Google Scholar 

  20. Toki A, Ogura K, Sato Y (1995) Peritoneal lavage versus drainage for perforated appendicitis in children. Surg Today 25(3):207–210

    Article  CAS  PubMed  Google Scholar 

  21. Pessaux P, Msika S, Flamant Y (2003) Risk factors for postoperative infectious complications in noncolorectal abdominal surgery. Arch Surg 138:314–324

    Article  PubMed  Google Scholar 

  22. Kokoska ER, Silen ML, Webwe TR (1998) Perforated appendicitis in children: risk factors for development of complications. Surgery 124(4):619–626

    Article  CAS  PubMed  Google Scholar 

  23. Alloo J, Gerstle T, Ein SH (2004) Appendicitis in children less than 3 years of age: a 28-year review. Pediatr Surg Int 19:777–779

    Article  PubMed  Google Scholar 

  24. Neilson IR, Laberge JM, Nguyen LT, Moir C, Doody D, Sonnino RE, Youssef S, Guttman FM (1990) Appendicitis in children: current therapeutic recommendations. J Pediatr Surg 25(11):1113–1116

    Article  CAS  PubMed  Google Scholar 

  25. Narci A, Karaman I, Karaman A, Erdoğan D, Cavuşoğlu YH, Aslan MK, Cakmak O (2007) Is peritoneal drainage necessary in childhood perforated appendicitis?—a comparative study. J Pediatr Surg 42(11):1864–1868

    Article  PubMed  Google Scholar 

  26. Petrowsky H, Demartines N, Clavien PA (2004) Evidence-based values of prophylactic drainage in gastrointestinal surgery. Ann Surg 240:1074–1085

    Article  PubMed  Google Scholar 

  27. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed  Google Scholar 

  28. Schein M (2008) To drain or not to drain? The role of drainage in the contaminated and infected abdomen: an international and personal perspective. World J Surg 32(2):312–321

    Article  PubMed  Google Scholar 

  29. Gurusamy KS, Samraj K, Mullerat P, Davidson BR (2007) Routine abdominal drainage for uncomplicated laparoscopic cholecystectomy. Cochrane Database Syst Rev 17(4):CD006004

    Google Scholar 

  30. Wittmann DH, Schein M, Condon RE (1996) Management of secondary peritonitis. Ann Surg 224(1):10–18

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois, University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland

    Pierre Allemann, Herve Probst, Nicolas Demartines & Markus Schäfer

Authors
  1. Pierre Allemann
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  2. Herve Probst
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  3. Nicolas Demartines
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  4. Markus Schäfer
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Corresponding author

Correspondence to Nicolas Demartines.

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Author contributions

• Study conception and design: Allemann Pierre, Probst Hervé, Demartines Nicolas

• Acquisition of data: Allemann Pierre

• Analysis and interpretation of data: Allemann Pierre, Probst Hervé, Schäfer Markus

• Drafting of manuscript: Allemann Pierre, Probst Hervé, Schäfer Markus

• Critical revision of manuscript: Demartines Nicolas, Schäfer Markus

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Allemann, P., Probst, H., Demartines, N. et al. Prevention of infectious complications after laparoscopic appendectomy for complicated acute appendicitis—the role of routine abdominal drainage. Langenbecks Arch Surg 396, 63–68 (2011). https://doi.org/10.1007/s00423-010-0709-z

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  • DOI: https://doi.org/10.1007/s00423-010-0709-z

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