Advantages comparison of peritoneal drainage versus no drainage after laparoscopic appendectomy for complicated appendicitis

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“Acute appendicitis is a prevalent acute abdominal condition necessitating emergency surgical intervention. Laparoscopic appendectomy (LA) has rapidly evolved as the standard of care treatment for acute appendicitis. For decades, placing an intra-abdominal drainage tube following LA has been perceived as beneficial in averting the development of postoperative abdominal abscesses, monitoring postoperative abdominal bleeding, and preventing postoperative appendix stump leakage. The rationale behind peritoneal drainage stemmed from the widespread belief among surgeons that the accumulation of inflammatory exudate within the abdominal cavity escalated the risk of postoperative complications, including intra-abdominal abscesses, appendix stump leakage, wound infections, and intestinal obstructions. However, the past few years have witnessed unprecedented scientific progress, which has translated into improved surgical, and the necessity of peritoneal drainage following LA has come under increasing scrutiny.”

Primary outcomes following peritoneal drainage versus no peritoneal drainage for laparoscopic appendectomy in term of A bowel obstruction, B intra-abdominal abscess, C appendix stump leakage, D wound infection and E postoperative VAS score Green squares represent the point estimates of the treatment effect OR, with 95% CI indicated by horizontal bars. Blue diamonds represent the summary estimate from the pooled studies with 95% CI

“Peritoneal drainage has long been thought to be beneficial for preventing abdominal infections, particularly in cases of infectious diseases or postoperative abdominal
inflammatory conditions. Indwelling PD catheters have been regarded as a useful method for preventing the accumulation of inflammatory effusions and promoting the formation of fistulas. Consequently, the concept of “no surgical infection, no drain” gained widespread acceptance among surgeons. However, the necessity of drainage following surgery has been under scrutiny. As research on the advantages and disadvantages of abdominal drainage for surgical patients has accumulated, an increasing number of studies have
indicated that PD may have adverse effects on patients who undergo surgical procedures. These studies have shown that PD can increase the incidence of surgical site infections, intra-abdominal abscesses, and small bowel obstructions caused by adhesions, prolong patient hospitalization times, and increase expenses.”

Wu, Hongsheng et al. “Advantages comparison of peritoneal drainage versus no drainage after laparoscopic appendectomy for complicated appendicitis: a meta-analysis.” BMC gastroenterology vol. 24,1 411. 16 Nov. 2024

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