The utility of peritoneal drains in patients with perforated appendicitis

SpringerPlus, Jul 2015

Background Intra-abdominal abscesses are the most common complication after perforated appendicitis and remain a significant problem ranging in incidence from 14 to 18%. Drainage following appendectomy is usually determined by whether the underlying appendicitis is simple or complicated and largely determined by the surgeons’ belief, based on expertise or personal opinion. In this report we discuss the results of patients diagnosed with peritoneal drainage, treated with or without a peritoneal drain. Patients and methods A retrospective study of patients diagnosed with perforated appendicitis having surgery was performed. Patients diagnosed with perforated appendicitis treated with a peritoneal drain and patients treated without a peritoneal drain. Both groups were evaluated in terms of complications: intra-abdominal abscess, re-intervention, readmission and duration of hospital stay. Results 199 patients diagnosed with perforated appendicitis underwent appendectomy. 120 patients were treated without a peritoneal drain and 79 patients with a peritoneal drain. Thirty-one (26%) patients from the group without a peritoneal drain had a re-intervention compared to 9 (11%) in the group with a peritoneal drain (p = 0.013). Overall complications and readmission were also significantly lower in patients treated with a peritoneal drain. Conclusion A peritoneal drain seems to reduce overall complication rate, re-intervention rate and readmission rate in patients treated with perforated appendicitis.

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The utility of peritoneal drains in patients with perforated appendicitis

Beek et al. SpringerPlus The utility of peritoneal drains in patients with perforated appendicitis Martinus A Beek 0 Tim S Jansen 0 Jelle W Raats 0 Eric L L Twiss 1 Paul D Gobardhan 0 Eric J H van Rhede van der Kloot 0 0 Department of Surgery, Amphia Hospital , Molengracht 21, 4818 CK Breda , The Netherlands 1 Department of Surgery, VU University Medical Center , De Boelelaan 1117, 1081 HV Amsterdam , The Netherlands Background: Intra-abdominal abscesses are the most common complication after perforated appendicitis and remain a significant problem ranging in incidence from 14 to 18%. Drainage following appendectomy is usually determined by whether the underlying appendicitis is simple or complicated and largely determined by the surgeons' belief, based on expertise or personal opinion. In this report we discuss the results of patients diagnosed with peritoneal drainage, treated with or without a peritoneal drain. Patients and methods: A retrospective study of patients diagnosed with perforated appendicitis having surgery was performed. Patients diagnosed with perforated appendicitis treated with a peritoneal drain and patients treated without a peritoneal drain. Both groups were evaluated in terms of complications: intra-abdominal abscess, re-intervention, readmission and duration of hospital stay. Results: 199 patients diagnosed with perforated appendicitis underwent appendectomy. 120 patients were treated without a peritoneal drain and 79 patients with a peritoneal drain. Thirty-one (26%) patients from the group without a peritoneal drain had a re-intervention compared to 9 (11%) in the group with a peritoneal drain (p = 0.013). Overall complications and readmission were also significantly lower in patients treated with a peritoneal drain. Conclusion: A peritoneal drain seems to reduce overall complication rate, re-intervention rate and readmission rate in patients treated with perforated appendicitis. Perforated appendicitis; Peritoneal drainage; Complications; Peritoneal drain - Background The lifetime risk of appendicitis is 9% for men and 7% for women (Addiss et  al. 1990). Acute appendicitis is a common disease with a peak incidence between 15 and 30  years. Acute appendicitis remains the most common general surgical emergency seen in most hospitals and the most common cause of acute abdomen requiring surgical intervention. In contrast to acute uncomplicated appendicitis, the perforated form is related to an increased risk of postoperative complications and is related to adverse outcome. Intra-abdominal abscesses are the most common complication after perforated appendicitis and remain a significant problem ranging in incidence from 14 to 18% (Fraser et al. 2010; St Peter et al. 2008a, b). In contrast to patients with acute uncomplicated appendicitis, reporting incidence form 1–2% (St Peter et al. 2008b). Peritoneal drainage is widely used by surgeons in current clinical practice. Leaving a drain in the peritoneal cavity in case of perforated appendicitis, intraabdominal abscess formation after appendectomy could potentially be prevented (Curran and Muenchow 1993; Fishman et al. 2000; Lund and Murphy 1994). Retention of possible contaminated intra-abdominal fluids could be drained timely. Nevertheless, routine peritoneal drainage after appendectomy in case of perforated appendicitis remains topic of debate (Narci et  al. 2007). Many surgeons use peritoneal drains selectively now (Dandapat and Panda 1992; © 2015 Beek et al. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Schwartz et al. 1983; Yamini et al. 1998), although others recommend routinely use of drains in case of perforated appendicitis (Curran and Muenchow 1993; Fishman et al. 2000; Lund and Murphy 1994). In addition, the impact of an abscess on patient outcome is tremendous and directly increases hospital stay and hospital costs (Gasior et al. 2013). Therefore, prevention of intra-abdominal abscesses after appendectomy is of major importance. Although many studies have reported outcomes after appendectomy concerning perforated appendicitis, there is still major controversy regarding the optimal management of perforated appendicitis. In this study we report results of patients operated for perforated appendicitis, treated with or without peritoneal drainage in current clinical practice. Patients and methods Patients All patients treated in our hospital for acute appendicitis between January 2011 and August 2013 enrolled the study cohort. Patients with uncomplicated appendicitis and patients with a malignancy (after pathological examination) were excluded (n = 1,029). A total of 199 patient (...truncated)


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Martinus A Beek, Tim S Jansen, Jelle W Raats, Eric L L Twiss, Paul D Gobardhan, Eric J H van Rhede van der Kloot. The utility of peritoneal drains in patients with perforated appendicitis, SpringerPlus, 2015, pp. 371, Volume 4, Issue 1, DOI: 10.1186/s40064-015-1154-9