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World J Surg Proced. Nov 28, 2013; 3(3): 18-24
Published online Nov 28, 2013. doi: 10.5412/wjsp.v3.i3.18
Intraperitoneal drains during open appendicectomy for gangrenous and perforated appendicitis
Gianpiero Gravante, John Overton, Mohamed Elshaer, Roberto Sorge, Ashish Kelkar
Gianpiero Gravante, Mohamed Elshaer, Ashish Kelkar, Department of Colorectal Surgery, Kettering General Hospital, Kettering, Northamptonshire, NN16 8UZ, United Kingdom
John Overton, Department of Colorectal Surgery, Royal Oldham Hospital, Oldham, OL1 2JH, United Kingdom
Roberto Sorge, Department of Human Physiology, Laboratory of Biometry, University of Tor Vergata, 00133 Rome, Italy
Author contributions: Gravante G and Kelkar A ideated the study; Gravante G, Overton J, Elshaer M and Sorge R collected the articles, analysed their results and wrote the review; all authors critically revised the study and approved the final draft.
Correspondence to: Gianpiero Gravante, BSC, MBBS, PhD, Department of Colorectal Surgery, Kettering General Hospital, Rothwell Road 10, Kettering, Northamptonshire, NN16 8UZ, United Kingdom.
Telephone: +44-11-62168244 Fax: +39-62-33216592
Received: September 8, 2013
Revised: November 6, 2013
Accepted: November 20, 2013
Published online: November 28, 2013

Intra-abdominal drains are still routinely used in the surgical management of gangrenous and perforated appendicitis. A systematic review was performed with the aim of establishing their influence on postoperative complications in such cases. A literature search was conducted using the search engines PubMed and Cochrance Central Register of Controlled Trials. Included were retrospective case-controlled and prospective randomized controlled trials on the use of drain for open appendicectomy in gangrenous and perforated appendicitis. Twelve articles were found that met the inclusion criteria. Intrabdominal abscesses, postoperative ileus, surgical site infections, fecal fistulas and burst abdomen had significant higher incidences in the drain vs non drain group (10.3%, 20.3%, 32.5%, 3.4% and 5.7% vs 4.7%, 8.5%, 16.2%, 0% and 0%, respectively). In most cases the risk was more than doubled in the drain group compared to the non-drain one. There were no significant differences among groups in terms of mortality while the results were underpowered to effectively evaluate wound dehiscence and adhesions. The use of intra-abdominal drains in the management of gangrenous and perforated appendicitis by open appendicectomy is associated with an increased rate of common postoperative complications.

Keywords: Appendix, Appendicectomy, Complications, Infections, Drains

Core tip: The prophylactic use of intraperitoneal drains for the prevention of postoperativeabdominal abscesses in cases of gangrenous or perforated appendicitis remains a contentious issue, particularly considering that recent enhanced recovery programs have frequently excluded their usage in colorectal operations. With regards to open appendicectomy, most studies demonstrate an increase in the incidence of postoperative abscesses, ileus and surgical site infections in patients in whom a drain was used and currently question their routine in cases of gangrenous and perforated appendicitis.