Evaluation of drain insertion after appendicectomy for complicated appendicitis : a systematic review and meta-analysis of 17 studies

Abstract

Introduction Surgical drains are used to reduce post-appendicectomy collections. However, they can cause considerable discomfort or increase the risk of surgical site infection (SSI), among other problems. Our aim is to review the literature systematically and conduct a meta-analysis to assess the advantages of using drains (DG) versus no drain (NDG) in complicated appendicitis.

Methods This systematic review was conducted in accordance with the Cochrane Handbook for Systematic Reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. All randomized control trials, comparative observational studies comparing outcomes of drain or no drain after appendicectomy for patients with complicated appendicitis were considered.

Results Seventeen studies (n=4255 patients) who underwent appendicectomy for complicated appendicitis with drain (DG=1580) without a drain (NDG=2657) were included. There was no difference between the two groups regarding abdominal collection [Odd ratio (OR)=1.41, P=0.13] and mortality [ risk difference (RD)= 0.01, p= 0.18]. NDG was superior to the DG regarding SSI [OR=1.93, P= 0.0001], faecal fistula [OR=4.76, P= 0.03], Intestinal obstruction [OR=2.40, P= 0.04], and ileus [ OR=2.07, P=0.01]. The No-drain group showed statistically significant shorter LOS when compared to the drain group [MD 1.79, 95% CI (1.25, 2.34), P= 0.00001].

Conclusion In conclusion, this meta-analysis has shown that drains have no effect on the development of intra-abdominal collections in complicated appendicitis, but it can significantly increase the risk of post-operative complications such as fistula, surgical site of infection (SSI), bowel obstruction, ileus, and prolonged hospital length of stay.