He Jun, Qian Gang, Mao Yefei, Gao Lei
Department of General Surgery, Zhangjiagang Third People's Hospital, Zhangjiagang, China.
Front Surg. 2025 Jul 18;12:1617312. doi: 10.3389/fsurg.2025.1617312. eCollection 2025.
The utility of abdominal drainage is common in laparoscopic appendectomy (LA) for acute appendicitis with perforation to prevent postoperative complications, such as intraabdominal abscess (IAA) and stump fistula. Nevertheless, the drain tube placement is considered to be associated with postoperative IAA formation in cases of complicated appendicitis. Our study aims to determine whether early removal of abdominal drainage tube after LA can improve prognosis for patients with perforated appendicitis.
A total of 182 patients who underwent abdominal drainage tube placement during LA due to acute appendicitis with perforation were divided into experimental group and control group by random number table method, including 87 patients in the experimental group and 95 patients in the control group. Patients in the experimental group had their abdominal drainage tube removed within 48 h after surgery. Patients in the control group removed the drainage tube after 48 h routinely. Variables of demographic and clinical characteristics of these patients between the two groups were analyzed. Postoperative outcomes, including overall complications, IAA, superficial surgical site infection (SSI), stump fistula, ileus, bleeding, postoperative length of stay (LOS), hospitalization costs and readmission to hospital, were compared.
These two groups were similar regarding demographic and perioperative clinical characteristics like age, sex, duration of symptoms and hematological examination indicators ( > 0.05). Although there was no significant difference in superficial SSI and ileus between the two groups ( > 0.05), patients in the experimental group was associated with a lower rate of overall complications (3.4% vs. 17.9%, = 0.002), declined incidence of IAA (3.4% vs. 11.6%, = 0.040), a shorter LOS [4 (4,4) vs. 6 (5,6) days, < 0.001] and less hospitalization costs [9,705 (8,621-10,402) vs. 10,851 (9,704-11,752) CNY, < 0.001] compared with patients in the control group. No stump fistula and intraabdominal bleeding occurred in both groups. There was no significant difference in readmission rate within 30 days after surgery between the two groups ( = 0.684).
It is safe and effective to remove abdominal drainage tube within 48 h after LA for patients with perforated appendicitis. This approach can accelerate the recovery time, decline the incidence of IAA and reduce hospitalization costs.
在腹腔镜阑尾切除术（LA）治疗急性穿孔性阑尾炎时，放置腹腔引流管以预防术后并发症，如腹腔内脓肿（IAA）和残端瘘，这一做法很常见。然而，在复杂阑尾炎病例中，放置引流管被认为与术后IAA形成有关。我们的研究旨在确定LA术后早期拔除腹腔引流管是否能改善穿孔性阑尾炎患者的预后。
将182例因急性穿孔性阑尾炎在LA术中放置腹腔引流管的患者，采用随机数字表法分为试验组和对照组，试验组87例，对照组95例。试验组患者在术后48小时内拔除腹腔引流管。对照组患者常规在48小时后拔除引流管。分析两组患者的人口统计学和临床特征变量。比较术后结局，包括总体并发症、IAA、手术切口浅层感染（SSI）、残端瘘、肠梗阻、出血、术后住院时间（LOS）、住院费用和再次入院情况。
两组在年龄、性别、症状持续时间和血液学检查指标等人口统计学和围手术期临床特征方面相似（P>0.05）。虽然两组在手术切口浅层感染和肠梗阻方面无显著差异（P>0.05），但试验组患者的总体并发症发生率较低（3.4%对17.9%，P=0.002），IAA发生率下降（3.4%对11.6%，P=0.040），住院时间较短[4（4，4）天对6（5，6）天，P<0.001]，住院费用较少[9705（8621 - 10402）元对10851（9704 - 11752）元，P<0.001]，与对照组患者相比。两组均未发生残端瘘和腹腔内出血。两组术后30天内的再次入院率无显著差异（P=0.684）。
对于穿孔性阑尾炎患者，LA术后48小时内拔除腹腔引流管是安全有效的。这种方法可以加快恢复时间，降低IAA发生率并减少住院费用。
