Schmidt Yannick Michael, Wendling-Keim Danielle, von Schweinitz Dietrich, Hubertus Jochen, Berger Michael
Department of Pediatric Surgery, Research Laboratories, Dr. von Hauner Children's Hospital, Ludwig Maximilian University of Munich, Munich, Germany.
Front Pediatr. 2020 Oct 9;8:588109. doi: 10.3389/fped.2020.588109. eCollection 2020.
Prophylactic abdominal drains for perforated appendicitis in children have generally been regarded as obsolete because several studies showed inferior results for drain placement in the past. Despite these results, prophylactic abdominal drains for perforated appendicitis remain omnipresent in pediatric surgery especially when gross spillage is observed at the time of appendectomy. Here, we hypothesize that even if accounting for gross intra-abdominal spillage, prophylactic drain placement for perforated appendicitis in children is not beneficial. The charts of all children (<18 years) who underwent an appendectomy at our institution from July 2013 to March 2020 were analyzed. The data from 65 patients who presented with perforated appendicitis were included. Patients were grouped according to the amount of intraoperative spillage. Demographics, laboratory data, operative findings, and postoperative outcomes were analyzed. Of all patients, 34 were male, and 31 were female, with a mean age of 10.5 ± 3.7 years. There were no statistically significant differences between the groups for age and sex ( = 0.6985 and = 0.6222, respectively). Prophylactic drains were placed according to the surgeon's preference in 32 children. There were no statistically significant differences between the groups in the rate of intra-abdominal abscess formation, wound infection, and bowel obstruction, regardless of the amount of spillage encountered during an appendectomy. However, independently of the amount of spillage, the length of hospital stay was longer in the children in which a drain had been placed ( = 0.0041). In our cohort, we could not find a benefit from drain placement even in case of gross spillage at the time of appendectomy. Rather, drain placement was associated with an increase in length of hospital stay.
儿童穿孔性阑尾炎预防性放置腹腔引流管通常被认为已过时，因为过去的几项研究表明引流管放置效果较差。尽管有这些结果，但儿童穿孔性阑尾炎预防性放置腹腔引流管在小儿外科手术中仍然普遍存在，尤其是在阑尾切除术中观察到大量腹腔污染时。在此，我们假设，即使考虑到腹腔内大量污染，儿童穿孔性阑尾炎预防性放置引流管也并无益处。我们分析了2013年7月至2020年3月在我院接受阑尾切除术的所有18岁以下儿童的病历。纳入了65例穿孔性阑尾炎患儿的数据。根据术中污染量对患者进行分组。分析了人口统计学、实验室数据、手术结果和术后结局。所有患者中，男性34例，女性31例，平均年龄10.5±3.7岁。两组在年龄和性别方面无统计学显著差异（分别为 = 0.6985和 = 0.6222）。32例儿童根据外科医生的偏好放置了预防性引流管。无论阑尾切除术中遇到的污染量如何，两组在腹腔脓肿形成、伤口感染和肠梗阻发生率方面均无统计学显著差异。然而，与污染量无关，放置引流管的儿童住院时间更长（ = 0.0041）。在我们的队列中，即使在阑尾切除术中出现大量污染的情况下，我们也未发现放置引流管有任何益处。相反，放置引流管与住院时间延长有关。
