Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC.
Division of Colorectal Surgery, Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan, ROC.
World J Emerg Surg. 2022 Mar 17;17(1):16. doi: 10.1186/s13017-022-00421-3.
This study aimed to evaluate the necessity of abdominal drainage after laparoscopic appendectomy in patients with complicated appendicitis.
Patients with acute appendicitis undergoing laparoscopic appendectomy at two hospitals between January 2014 and December 2018 were retrospectively included. Complicated appendicitis was defined as the American Association for the Surgery of Trauma (AAST) grade ≥ II. The patients were classified according to the AAST grade and the indwelling of abdominal drainage. The postoperative surgical outcomes and recovery were compared among patient groups to evaluate the impact of abdominal drainage for patients with complicated appendicitis undergoing laparoscopic appendectomy.
A total of 1241 patients was retrospectively included. Among them, there were 820 patients with simple appendicitis (AAST grade I) and 421 patients with complicated appendicitis (AAST grade ≥ II). For complicated appendicitis, the drainage group (N = 192) tended to harbor more overall complications, intra-abdominal abscess formation, time to resume a soft diet, and the postoperative length of hospitalization (P = 0.0000 for all). Multivariate logistic regression confirmed that abdominal drainage increased the risk of overall complications [Odds ratio (OR) 2.439; 95% confidence interval (CI) 1.597-3.726; P ≤ 0.0001] and failed to decrease the risk of intra-abdominal abscess formation (OR 1.655; 95% CI 0.487-5.616; P = 0.4193). Multivariate linear regression analysis also showed that the drainage group harbored longer postoperative length of hospitalization (Coefficients: 20.697; 95% CI 15.251-26.143; P < 0.0001) and time to resume a soft diet (Coefficients: 45.899; 95% CI 34.502-57.297; P < 0.0001).
Abdominal drainage did not prevent overall complications in patients with complicated appendicitis; paradoxically, it delayed the convalescence. Our results discourage the routine use of abdominal drainage and suggest that abdominal drainage should be performed sparingly.
本研究旨在评估复杂性阑尾炎患者行腹腔镜阑尾切除术后行腹腔引流的必要性。
回顾性纳入 2014 年 1 月至 2018 年 12 月期间在两家医院行腹腔镜阑尾切除术的急性阑尾炎患者。复杂性阑尾炎定义为美国创伤外科学会（AAST）分级≥Ⅱ级。根据 AAST 分级和腹腔引流情况对患者进行分类。比较各组患者的术后手术结果和恢复情况，以评估腹腔引流对行腹腔镜阑尾切除术的复杂性阑尾炎患者的影响。
共回顾性纳入 1241 例患者。其中，820 例为单纯性阑尾炎（AAST 分级 I），421 例为复杂性阑尾炎（AAST 分级≥Ⅱ级）。对于复杂性阑尾炎，引流组（N=192）总体并发症、腹腔脓肿形成、恢复软食时间和术后住院时间均较高（P 值均<0.0001）。多变量逻辑回归证实，腹腔引流增加了总体并发症的风险[比值比（OR）2.439；95%置信区间（CI）1.597-3.726；P≤0.0001]，但未能降低腹腔脓肿形成的风险（OR 1.655；95%CI 0.487-5.616；P=0.4193）。多变量线性回归分析也显示引流组术后住院时间较长（系数：20.697；95%CI 15.251-26.143；P<0.0001）和恢复软食时间较长（系数：45.899；95%CI 34.502-57.297；P<0.0001）。
腹腔引流并不能预防复杂性阑尾炎患者的总体并发症；相反，它会延迟康复。我们的结果不鼓励常规使用腹腔引流，并建议谨慎使用腹腔引流。
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