Prophylactic surgical drain placement with irrigation reduces abscess formation in patients with severe, uncontained, perforated appendicitis
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In brief
In brief
Multicenter retrospective study of 115 pediatric patients demonstrates that prophylactic closed-suction drain placement combined with irrigation significantly reduces postoperative abscess formation in severe perforated appendicitis (5.1% vs 33-37% without drains). The intervention eliminated need for interventional radiology drains while maintaining comparable hospital stays and antibiotic duration.
- Prophylactic surgical drain with irrigation reduced abscess rate to 5.1% vs 33-37% without both interventions in perforated appendicitis.
- Surgical drains placed prophylactically avoided need for IR drainage, which required significantly longer duration (8-14 days vs 2-4 days).
- Irrigation alone or drain alone showed similar abscess rates (~33%), suggesting synergistic benefit when combined.
- No difference in total hospital stay or antibiotic duration despite lower abscess rates with drain plus irrigation.
- Drains should be oriented toward pelvis in uncontained perforated appendicitis to maximize prophylactic benefit.
Written by the GCMD Library team from the article.
Abstract
Background
20–25% of perforated appendicitis cases are complicated by abscess formation. This study assesses whether prophylactic closed-suction surgical drain (SD) placement after irrigation can decrease postoperative abscess formation in patients with extensively contaminated, perforated appendicitis.Affiliations: Journal instruction requires country for affiliations; however, these are missing in all affiliations. Please verify if the provided country names are correct and amend if necessary.They're correct
Methods
A multicenter retrospective review was performed on pediatric patients with uncontained perforated appendicitis from January 1, 2020 to August 1, 2023. Limited irrigation was performed. All SDs were oriented towards the pelvis. Data were analyzed in four groups: (G1) SD and irrigation, (G2) only SD, (G3) only irrigation, (G4) neither SD nor irrigation.
Results
One hundred and fifteen patients (44 in G1, 3 in G2, 21 in G3, 47 in G4) were included. The abscess rate was 5.1% (G1), 33.3% (G2), 33.3% (G3), and 37.0% (G4) (p = 0.001). No interventional radiology (IR) drains were placed in G1 and G2. SD duration was 4.1 ± 2.1 days in G1 and 2.7 ± 0.6 days in G2. IR drain duration was 14 ± 10.7 days in G3 and 8.3 ± 3.9 days in G4 (p < 0.001). There were no significant differences in total length of stay and antibiotic duration.
Conclusions
Irrigation with prophylactic SD placement may prevent postoperative abscesses in patients with severe, uncontained, perforated appendicitis, but prospective data are needed.