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
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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;
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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)