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Safety and Efficacy of Intra-abdominal Drainage After Open Appendectomy in Patients with Perforated Appendicitis: A Prospective Cohort Study
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Hossein Sadeghi Hassan Abadi    , Marzieh Naghavi Ravandi , Abdoulhossein Davoudabadi , Esmaeel Abdolrahim Kashi , Emad Fayyazi * |
| Doctor of Medicine, Department of General Surgery, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran , emad.fayyazi@gmail.com |
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Abstract: (27 Views) |
Background and Aim: Perforated appendicitis is one of the most common surgical emergencies and is associated with a high risk of postoperative complications, particularly surgical site infection and prolonged hospitalization. The use of intra-abdominal drains after open appendectomy has been proposed to reduce these complications, but the available evidence remains conflicting. This study aimed to determine the effect of routine intra-abdominal drain placement after open appendectomy in patients with perforated appendicitis on postoperative outcomes compared with no drain use.
Materials and Methods: This prospective cohort study was conducted from 2021 to 2024 at Shahid Beheshti Hospital in Kashan, Iran. A total of 220 patients with perforated appendicitis were included and allocated into two groups: the drain group (n=108) and the no-drain group (n=112). Primary outcomes included intra-abdominal abscess, surgical site infection, and postoperative bowel obstruction. Secondary outcomes included duration of fever, length of hospital stay, and hospitalization costs. Data were analyzed using the independent t-test, chi-square test, Fisher’s exact test, and linear regression with SPSS version 23.
Results: Intra-abdominal abscess was observed in 18.5% of patients in the drain group, while no cases occurred in the no-drain group (P=0.001). Surgical site infection occurred in 11.1% of the drain group and 21.4% of the no-drain group (P=0.036). Postoperative bowel obstruction developed in 7.4% of patients with drains, whereas no such cases were reported in the no-drain group (P=0.003). The mean length of hospital stay was significantly longer in the drain group (9.1±0.3 days) than in the no-drain group (4.8±0.3 days) (P<0.001). Postoperative pain scores were 5.5±1.3 in the drain group and 4.8 ± 0.9 in the no-drain group, with no significant difference between groups (P=0.09). The mean duration of postoperative antibiotic therapy was significantly longer in patients with drains, by an average of 4.5±3.6 days, compared with those without drains (P<0.001).
Conclusion: Although intra-abdominal drain placement after open appendectomy in patients with perforated appendicitis may reduce the rate of surgical site infection, it is also associated with increased intra-abdominal abscess formation, bowel obstruction, and longer hospital stay. Routine drain use in these patients is therefore not recommended, and further studies are warranted to define the optimal indications for its use. |
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| Keywords: Intra-abdominal drainage, open appendectomy, perforated appendicitis, intra-abdominal abscess, surgical site infection, small bowel obstruction |
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Type of Study: Research |
Subject:
General
Received: 2025/08/5 | Revised: 2025/10/8 | Accepted: 2025/10/8
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