Skip to main content
Top
Published in: Pediatric Surgery International 9/2022

Open Access 30-06-2022 | Laparoscopy | Original Article

Laparoscopic appendectomy for complicated appendicitis in children: does the post-operative peritoneal drain make any difference? A pilot prospective randomised controlled trial

Authors: M. J. Human, N. Tshifularo, M. Mabitsela

Published in: Pediatric Surgery International | Issue 9/2022

Login to get access

Abstract

Purpose

This was a pilot randomised, prospective study, which aimed to determine and compare the post-operative complications of paediatric patients undergoing laparoscopic appendectomy (LA) for complicated appendicitis, with and without a peritoneal drain.

Methods

Patients younger than 13 years, undergoing LA for complicated appendicitis at the Dr George Mukhari Academic Hospital (DGMAH), over a 15-month period during 2019–2020 were enrolled. Randomisation was achieved by a blocked randomisation plan. Patients were randomised in a 1:1 ratio into the “drain” (D) and “no drain” (ND) groups.

Results

Thirty-four patients were included in this study; seventeen in each group. The complication rate was 26%. Intra-abdominal collection accounted for 89% of the complications. The complication rate in the “D” group was 18% and 35% in the “ND” group, with no statistically significant difference. Complication rates were higher (38%) in patients with generalised pus when compared to localised pus (7%), although not statistically significant. The mean theatre time, hospital stay, and duration of antibiotic use did not differ significantly between the groups.

Conclusion

From our study, the post-operative peritoneal drain did not make any statistically significant difference in patient outcome. The amount of intra-abdominal contamination is more likely to contribute in the development of complications.

Trial registration number

SMUREC/M/15/2019: PG.
Literature
1.
go back to reference Markar SR, Blackburn S, Cobb R, Karthikesalingam A, Evans J, Kinross J et al (2012) Laparoscopic versus open appendectomy for complicated and uncomplicated appendicitis in children. J Gastrointest Surg 16(10):1993–2004CrossRef Markar SR, Blackburn S, Cobb R, Karthikesalingam A, Evans J, Kinross J et al (2012) Laparoscopic versus open appendectomy for complicated and uncomplicated appendicitis in children. J Gastrointest Surg 16(10):1993–2004CrossRef
2.
go back to reference Ali R, Anwar M, Akhtar J (2018) Laparoscopic versus open appendectomy in children: a randomized controlled trial from a developing country. J Pediatr Surg 53(2):247–249CrossRef Ali R, Anwar M, Akhtar J (2018) Laparoscopic versus open appendectomy in children: a randomized controlled trial from a developing country. J Pediatr Surg 53(2):247–249CrossRef
3.
go back to reference Aziz O, Athanasiou T, Tekkis PP, Purkayastha S, Haddow J, Malinovski V et al (2006) Laparoscopic versus open appendectomy in children: a meta-analysis. Ann Surg 243(1):17–27CrossRef Aziz O, Athanasiou T, Tekkis PP, Purkayastha S, Haddow J, Malinovski V et al (2006) Laparoscopic versus open appendectomy in children: a meta-analysis. Ann Surg 243(1):17–27CrossRef
4.
go back to reference Lin HF, Lai HS, Lai IR (2014) Laparoscopic treatment of perforated appendicitis. World J Gastroenterol 20(39):14338–14347CrossRef Lin HF, Lai HS, Lai IR (2014) Laparoscopic treatment of perforated appendicitis. World J Gastroenterol 20(39):14338–14347CrossRef
5.
go back to reference Low ZX, Bonney GK, So JBY, Loh DL, Ng JJ (2019) Laparoscopic versus open appendectomy in pediatric patients with complicated appendicitis: a meta-analysis. Surg Endosc 33(12):4066–4077CrossRef Low ZX, Bonney GK, So JBY, Loh DL, Ng JJ (2019) Laparoscopic versus open appendectomy in pediatric patients with complicated appendicitis: a meta-analysis. Surg Endosc 33(12):4066–4077CrossRef
6.
go back to reference Gomes CA, Sartelli M, di Saverio S, Ansaloni L, Catena F, Coccolini F et al (2015) Acute appendicitis: Proposal of a new comprehensive grading system based on clinical, imaging and laparoscopic findings. World J Emerg Surg 10:Article 60CrossRef Gomes CA, Sartelli M, di Saverio S, Ansaloni L, Catena F, Coccolini F et al (2015) Acute appendicitis: Proposal of a new comprehensive grading system based on clinical, imaging and laparoscopic findings. World J Emerg Surg 10:Article 60CrossRef
7.
go back to reference Sartelli M, Baiocchi GL, Di Saverio S, Ferrara F, Labricciosa FM, Ansaloni L et al (2018) Prospective observational study on acute appendicitis worldwide (POSAW). World J Emerg Surg 13:Article 19CrossRef Sartelli M, Baiocchi GL, Di Saverio S, Ferrara F, Labricciosa FM, Ansaloni L et al (2018) Prospective observational study on acute appendicitis worldwide (POSAW). World J Emerg Surg 13:Article 19CrossRef
8.
go back to reference Podany AB (2017) Acute appendicitis in pediatric patients: an updated narrative review. J Clin Gastroenterol Treat 3(1):1–9CrossRef Podany AB (2017) Acute appendicitis in pediatric patients: an updated narrative review. J Clin Gastroenterol Treat 3(1):1–9CrossRef
9.
go back to reference Wesson DE, Singer JI, Wiley JF (2021) Acute appendicitis in children: clinical manifestations and diagnosis. UpToDate Wesson DE, Singer JI, Wiley JF (2021) Acute appendicitis in children: clinical manifestations and diagnosis. UpToDate
10.
go back to reference Almaramhy HH (2017) Acute appendicitis in young children less than 5 years: review article. Ital J Pediatr 43:Article 15CrossRef Almaramhy HH (2017) Acute appendicitis in young children less than 5 years: review article. Ital J Pediatr 43:Article 15CrossRef
11.
go back to reference Kulik DM, Uleryk EM, Maguire JL (2013) Does this child have appendicitis? A systematic review of clinical prediction rules for children with acute abdominal pain. J Clin Epidemiol 66(1):95–104CrossRef Kulik DM, Uleryk EM, Maguire JL (2013) Does this child have appendicitis? A systematic review of clinical prediction rules for children with acute abdominal pain. J Clin Epidemiol 66(1):95–104CrossRef
12.
go back to reference St Peter SD, Adibe OO, Iqbal CW, Fike FB, Sharp SW, Juang D et al (2012) Irrigationversus suction alone during laparoscopic appendectomy for perforated appendicitis: a prospective randomized trial. Ann Surg 256(4):581–585CrossRef St Peter SD, Adibe OO, Iqbal CW, Fike FB, Sharp SW, Juang D et al (2012) Irrigationversus suction alone during laparoscopic appendectomy for perforated appendicitis: a prospective randomized trial. Ann Surg 256(4):581–585CrossRef
13.
go back to reference Bi LW, Yan BL, Yang QY, Cui HL (2019) Peritoneal irrigation vs suction alone during pediatric appendectomy for perforated appendicitis: a meta-analysis. Medicine (Balitmore) 98(50):e18047CrossRef Bi LW, Yan BL, Yang QY, Cui HL (2019) Peritoneal irrigation vs suction alone during pediatric appendectomy for perforated appendicitis: a meta-analysis. Medicine (Balitmore) 98(50):e18047CrossRef
14.
go back to reference Sardiwala II, Koto MZ (2019) Laparoscopic lavage versus suction only in complicatedacute appendicitis: a prospective randomized control trial. Int Surg 103(7–8):371–377 Sardiwala II, Koto MZ (2019) Laparoscopic lavage versus suction only in complicatedacute appendicitis: a prospective randomized control trial. Int Surg 103(7–8):371–377
15.
go back to reference Memon MA, Memon MI, Donohue JH (2001) Abdominal drains: a brief historical review. Ir Med J 94(6):164–166PubMed Memon MA, Memon MI, Donohue JH (2001) Abdominal drains: a brief historical review. Ir Med J 94(6):164–166PubMed
16.
go back to reference Petrowsky H, Demartines N, Rousson V, Clavien PA, Johnson A et al (2004) Evidence-based value of prophylactic drainage in gastrointestinal surgery: a systematic review and meta-analyses. Ann Surg 240(6):1074–1085CrossRef Petrowsky H, Demartines N, Rousson V, Clavien PA, Johnson A et al (2004) Evidence-based value of prophylactic drainage in gastrointestinal surgery: a systematic review and meta-analyses. Ann Surg 240(6):1074–1085CrossRef
17.
go back to reference Allemann P, Probst H, Demartines N, Schäfer M (2011) Prevention of infectious complications after laparoscopic appendectomy for complicated acute appendicitis—the role of routine abdominal drainage. Langenbeck’s Arch Surg 396(1):63–68CrossRef Allemann P, Probst H, Demartines N, Schäfer M (2011) Prevention of infectious complications after laparoscopic appendectomy for complicated acute appendicitis—the role of routine abdominal drainage. Langenbeck’s Arch Surg 396(1):63–68CrossRef
18.
go back to reference Aneiros Castro B, Cano I, García A, Yuste P, Ferrero E, Gómez A (2018) Abdominal drainage after laparoscopic appendectomy in children: an endless controversy? Scand J Sur 107(3):197–200CrossRef Aneiros Castro B, Cano I, García A, Yuste P, Ferrero E, Gómez A (2018) Abdominal drainage after laparoscopic appendectomy in children: an endless controversy? Scand J Sur 107(3):197–200CrossRef
19.
go back to reference Song RY, Jung K (2015) Drain insertion after appendectomy in children with perforated appendicitis based on a single-center experience. Ann Surg Treat Res 88(6):341–344CrossRef Song RY, Jung K (2015) Drain insertion after appendectomy in children with perforated appendicitis based on a single-center experience. Ann Surg Treat Res 88(6):341–344CrossRef
Metadata
Title
Laparoscopic appendectomy for complicated appendicitis in children: does the post-operative peritoneal drain make any difference? A pilot prospective randomised controlled trial
Authors
M. J. Human
N. Tshifularo
M. Mabitsela
Publication date
30-06-2022
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Surgery International / Issue 9/2022
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI
https://doi.org/10.1007/s00383-022-05155-6

Other articles of this Issue 9/2022

Pediatric Surgery International 9/2022 Go to the issue