Routine Use of Abdominal Drainage After Laparoscopic Appendectomy: Yes or No? Volume 5 - Issue 5

Jurij Janež*

• Department of abdominal surgery, University medical centre ljubljana, Slovenia, Europe

Received: June 13, 2018;   Published: June 20, 2018

*Corresponding author: Jurij Janež, Department of abdominal surgery, University medical centre ljubljana, Slovenia, Europe

DOI: 10.26717/BJSTR.2018.05.001261

Abstract PDF

Acute appendicitis is a common cause of abdominal pain and is one of the most common surgical abdominal emergencies. Surgical treatment of acute appendicits 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 abdomial 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 appendecotmy 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 contro versial. 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 laparscopic 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].

1. Di Saverio (2016) WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World Journal of Emergency Surgery 11: 34.
2. Katkhouda N, Friedlander MH, Grant SW, Achanta KK, Essani R, et al. (2000) Intraabdominal abscess rate after laparoscopic appendectomy. Am J Surg 180(6): 456-459.
3. Pakula AM, Skinner R, Jones A, Chung R, Martin M (2014) Role of drains in laparoscopic appendectomy for complicated appendicitis at a busy county hospital. Am Surg 80(10): 1078-1081.
4. Schlottmann F, Reino R, Sadava EE, Campos Arbulú A (2016) Could an abdominal drainage be avoided in complicated acute appendicitis? Lessons learned after 1300 laparoscopic appendectomies. Int J Surg 36(Pt A): 40-43.
5. Aneiros Castro B, Cano I, García A, Yuste P, Ferrero E, et al. (2018) Abdominal drainage after laparoscopic appendectomy in children: an endless controversy? Scand J Surg.