Abu Abduelraheim, Mohamedahmed Ali Yasen, Alamin Amin, Mohamed Mazin, Osman Mohamed, Mohammed Mohammed Jibreel, Abdalla Hiba, Eltyeb Hazim A, Ali Omer, Mohamad Rifat, Hamid Safaa, Faycal Mirghani Shaza, Hamad Yousif, Mohamed Hussam Khougali
General and Colorectal Surgery, Whipps Cross Hospital, London, GBR.
General Surgery, Royal Wolverhampton NHS (National Health Service) Trust, Birmingham, GBR.
Cureus. 2022 Nov 29;14(11):e32018. doi: 10.7759/cureus.32018. eCollection 2022 Nov.
This meta-analysis aims to evaluate the comparative outcomes of drain insertion versus no drain after appendicectomy for complicated appendicitis. A systematic search of PubMed, Cochrane Library and Scopus was conducted, and all studies comparing drain versus no drain after appendicectomy for complicated appendicitis were included. Abdominal collection, surgical site infection (SSI), bowel obstruction, faecal fistula, paralytic ileus, length of hospital stay (LOS) and mortality were the evaluated outcome parameters for the meta-analysis. Seventeen studies reporting a total number of 4,255 patients who underwent appendicectomy for complicated appendicitis with (n=1,580) or without (n=2,657) drain were included. There was no significant difference between the two groups regarding abdominal collection (odds ratio (OR)=1.41, P=0.13). No-drain group was superior to the drain group 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 paralytic ileus (OR=2.07, P=0.01). There was a difference regarding mortality rate between the two groups (3.4% in the drain group vs 0.5% in the no-drain group, risk difference (RD)=0.01, 95% CI (-0.01, 0.04), P=0.36). 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 postoperative complications such as fistula, surgical site infection (SSI), bowel obstruction, ileus and length of hospital stay.
本荟萃分析旨在评估复杂性阑尾炎阑尾切除术后放置引流管与不放置引流管的比较结果。我们对PubMed、Cochrane图书馆和Scopus进行了系统检索，纳入了所有比较复杂性阑尾炎阑尾切除术后放置引流管与不放置引流管的研究。腹部积液、手术部位感染（SSI）、肠梗阻、粪瘘、麻痹性肠梗阻、住院时间（LOS）和死亡率是本次荟萃分析的评估结局参数。纳入了17项研究，共4255例接受复杂性阑尾炎阑尾切除术的患者，其中放置引流管的有1580例，未放置引流管的有2657例。两组在腹部积液方面无显著差异（优势比（OR）=1.41，P=0.13）。在SSI（OR=1.93，P=0.0001）、粪瘘（OR=4.76，P=0.03）、肠梗阻（OR=2.40，P=0.04）和麻痹性肠梗阻（OR=2.07，P=0.01）方面，不放置引流管组优于放置引流管组。两组在死亡率方面存在差异（放置引流管组为3.4%，不放置引流管组为0.5%，风险差异（RD）=0.01，95%CI（-0.01，0.04），P=0.36）。总之，本荟萃分析表明，引流管对复杂性阑尾炎腹腔内积液的发生没有影响，但会显著增加术后并发症的风险，如瘘、手术部位感染（SSI）、肠梗阻、肠梗阻和住院时间。
