Drainage after laparoscopic appendectomy less and less justified

The systematic placement of a drain after laparoscopic appendectomy is controversial. Does this practice really reduce the risk of post-surgical infection, particularly in cases of complicated appendicitis?Not only does the peritoneal drain not reduce infections, but it also prolongs the length of hospital stay and causes patients more pain, a new study shows.Whether it's perforated appendicitis, periappendicular abscess or peritonitis, complicated appendicitis requires emergency surgery, usually performed laparoscopically. The placement of an intra-abdominal drain has long been considered beneficial in reducing the post-operative complications of this surgery. A recent meta-analysis of 12 comparative studies involving a total of 3,374 cases of complicated appendicitis operated on by laparoscopy has once again called into question the relevance of this practice.The researchers first looked at the benefits of drainage: Based on the available data, is it really effective in eliminating inflammatory exudate that might have accumulated in the abdominal cavity, and thus avoid abscesses or intestinal obstructions? After analysis, it seems that wound infections were more frequent in individuals with a peritoneal drain (OR 2.38, 95% CI 1.74-3.27). Based on the VAS scale, postoperative pain experienced was also slightly higher when a drain was placed.“Placing and removing a drainage tube can cause pain in patients. Avoiding this additional source of pain may contribute to better postoperative outcomes and patient satisfaction,” noted the study authors.Placing a drain would extend surgery time by an average of 13 minutes. However, postoperative recovery time increased by one day. Hospital stay was also extended by 1.47 days following placement of a peritoneal drain.“Not only does a drain fail to reduce postoperative complications, it also prolongs the duration of the operation and the hospital stay, resulting in higher medical costs,” they stated in the article published in BMC Gastroenterology.Not more useful in childrenIn children, postoperative abscess formation remains a serious complication in cases of perforated appendicitis. Studies on the pediatric population show that, in their case too, drainage fails to reduce the risk of infection. Comparing two groups with and without drainage, their infection rates were fairly similar, while cases of intestinal obstruction soared in the group with drainage.What's more, 29% of small patients with drainage developed an intra-abdominal abscess, compared with 22.6% of those without.

Drainage after laparoscopic appendectomy less and less justified

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