Aneiros Castro B, Cano I, García A, Yuste P, Ferrero E, Gómez A
1 Department of Pediatric Surgery, Hospital 12 de Octubre, Madrid, Spain.
2 Department of General Surgery, Hospital 12 de Octubre, Madrid, Spain.
Scand J Surg. 2018 Sep;107(3):197-200. doi: 10.1177/1457496918766696. Epub 2018 Apr 9.
Routine prophylactic abdominal drains after laparoscopic appendectomy for perforated appendicitis in children are still controversial. Throughout the history of surgery, potential benefits of the abdominal drains have been described. However, in recent studies, no benefits were observed and serious complications have been reported.
From January 2000 to December 2013, all charts of the pediatric patients who underwent laparoscopic appendectomy in our tertiary center were revised. The data from 1736 appendectomies were analyzed. We only included those patients with perforated appendicitis treated with early appendectomy (n = 192). Prophylactic drains were established according to the surgeon's preference. The sample was divided into two groups, those with drain (n = 117) and those without drain (n = 75). Demographics, operative findings, and postoperative outcomes were analyzed in both groups.
Of all patients, 121 were male and 71 were female with a mean age of 7.77 ± 3.4 years. There were not statistically significant differences between the groups in gender (p = 0.82) and mean age (p = 0.31). There were no statistically significant differences between the two groups in the rate of intra-abdominal abscess, wound infection, and bowel obstruction. However, the drainage group has been statistically associated with an increased requirement of antibiotic and analgesic medication, fasting time, operative time, and length of hospital stay.
The prophylactic use of abdominal drainage after laparoscopic appendectomy for perforated appendicitis in children does not prevent postoperative complications and may be associated with negative outcomes. Prospective randomized studies will be necessary to verify this question.
儿童穿孔性阑尾炎行腹腔镜阑尾切除术后常规预防性放置腹腔引流管仍存在争议。在外科手术史上，曾描述过腹腔引流管的潜在益处。然而，近期研究未观察到其益处，且有严重并发症的报道。
回顾2000年1月至2013年12月在我们三级中心接受腹腔镜阑尾切除术的所有儿科患者病历。分析1736例阑尾切除术的数据。我们仅纳入那些早期行阑尾切除术治疗的穿孔性阑尾炎患者（n = 192）。预防性引流管根据外科医生的偏好放置。样本分为两组，有引流管组（n = 117）和无引流管组（n = 75）。分析两组的人口统计学、手术发现及术后结果。
所有患者中，男性121例，女性71例，平均年龄7.77 ± 3.4岁。两组在性别（p = 0.82）和平均年龄（p = 0.31）上无统计学显著差异。两组在腹腔脓肿发生率、伤口感染及肠梗阻方面无统计学显著差异。然而，引流管组在抗生素和镇痛药使用需求增加、禁食时间、手术时间及住院时间方面与统计学相关。
儿童穿孔性阑尾炎行腹腔镜阑尾切除术后预防性使用腹腔引流管并不能预防术后并发症，且可能与不良结局相关。需要进行前瞻性随机研究来验证这一问题。
