Laparoscopic treatment of appendiceal peritonitis without drainage in children—A prospective randomized clinical trial

Abstract

Background: Routine placement of a drain for complicated appendicitis is one of the approaches to reduce postoperative complication. In a resource-limited hospital where radiologist-directed monitoring is not feasible, drainage is beneficial for complication follow-up. Nevertheless, emerging studies indicated drainage did not significantly impact on amelioration of patients’ outcomes. This study aimed to compare the postoperative results of pediatric patients with or without drainage after laparoscopic appendectomy for complicated appendicitis at a rural children's hospital. Methods: We performed a quasi-randomized recruitment of pediatric patients who underwent laparoscopic treatment for complicated appendicitis with or without drainage. Several parameters, including operative time, lengths of stay, complication rate, duration of antibiotic administration, and hospital charges were monitored for assessment. Results: From 05/2020 to 05/2022, there were 184 cases of recruited pediatric patients who underwent laparoscopic appendectomy for complicated appendicitis, with 91 patients in drain-placing group (49.5%). Demographic baseline and pre-surgery symptoms did not indicate any differences between two groups. Data of postoperative complications including intra-abdominal abscesses and wound infections showed no significance in discrepancy. Notably, patients of drainage group experienced longer length of stay than non-drainage group, with average of 8.5 days and 7.5 days, respectively (p<0.0001). Additionally, the significantly higher number of hospital charges was observed in the those with peritoneal drain (p<0.0001). Conclusion: Our records showed that routine placement of a peritoneal drain after laparoscopic appendectomy in pediatric patients with complicated appendicitis did not impact on the outcomes, but prolonged hospital stay and caused more hospital charges.

Keywords

• Laparoscopic appendectomy
• Complicated appendicitis
• Abdominal drainage
• Intra-abdominal abscess