Mini Review
Routine use of Abdominal Drainage after Laparoscopic Appendectomy: Yes or No?
Jurij Janež*
Department of Abdominal Surgery, University Medical Centre Ljubljana, Slovenia
*Corresponding author: Valioulis
Published: 15 May, 2018
Cite this article as: Janež J. Routine use of Abdominal Drainage after Laparoscopic Appendectomy: Yes or No?. World J Surg Surgical Res. 2018; 1: 1009.
Mini Review
Acute appendicitis is a common cause of abdominal pain and is one of the most common
surgical abdominal emergencies. Surgical treatment of acute appendicitis has undergone a paradigm
shift from open appendectomy to laparoscopic appendectomy, both in adults and in pediatric
patients [1]. In open appendectomy, a skin incision in the right inferior abdominal quadrant over
BcBurney point was performed and the appendix was removed through a relatively small wound.
An abdominal drain was rarely used. In laparoscopic appendectomy, we perform three small skin
incisions and insert three trocars into the abdominal cavity. The abdominal drains are used more
frequently than in open appendectomy, since certain studies suggested increased intra-abdominal
abscess rates following laparoscopic appendectomy, especially for perforated appendicitis [2].
The routine use of abdominal drain after laparoscopic appendectomy is still under debate.
None of the prospective randomized clinical trials has shown the benefits of routine drainage of the
abdominal cavity after laparoscopic appendectomy for uncomplicated acute appendicitis. Even in
complicated acute appendicitis, the placement of intra-abdominal drain may not present benefits
and may even lengthen hospital stay. Observations from some authors suggest that there is no need
of using a drain in laparoscopic appendectomy for complicated acute appendicitis [3]. However,
according to some other authors, the use of intra-abdominal drainage in patients with perforated
or gangrenous appendicitis during laparoscopic appendectomy has decreased rates of pelvic abscess
[4].
Routine prophylactic abdominal drains after laparoscopic appendectomy for perforated
appendicitis in children are still controversial. Throughout the history of surgery, potential benefits
of the abdominal drains have been described. However, in recent studies, no benefits were observed
and serious complications have been reported. The prophylactic use of abdominal drainage after
laparoscopic appendectomy for perforated appendicitis in children does not prevent postoperative
complications and may be associated with negative outcomes. Further prospective randomized
studies will be necessary to verify this question [5].
According to WSES Jerusalem guidelines from year 2016, drains are not recommended in
complicated appendicitis in pediatric patients. In adults, drain after appendectomy for perforated
appendicitis and abscess/peritonitis should be used with judicious cautin, given the absence of
good evidence from the literature. Drains did not prove any efficacy in preventing intra-abdominal
abscess and seem to be associated with delayed hospital discharge [1].
References
- Di Saverio S, Birindelli A, Kelly MD, Catena F, Weber DG, Sartelli M, et al. WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World J Emergency Surg. 2016;11:34.
- Katkhouda N, Friedlander MH, Grant SW, Achanta KK, Essani R, Paik P, et al. Intra abdominal abscess rate after laparoscopic appendectomy. Am J Surg. 2000;180(6):456-9.
- Pakula AM, Skinner R, Jones A, Chung R, Martin M. Role of drains in laparoscopic appendectomy for complicated appendicitis at a busy county hospital. Am Surg. 2014;80(10):1078-81.
- Schlottmann F, Reino R, Sadava EE, Campos Arbulú A, Rotholtz NA. Could an abdominal drainage be avoided in complicated acute appendicitis? Lessons learned after 1300 laparoscopic appendectomies. Int J Surg. 2016;36:40-3.
- Aneiros Castro B, Cano I, García A, Yuste P, Ferrero E, Gómez A. Abdominal drainage after laparoscopic appendectomy in children: an endless controversy? Scand J Surg. 2018.