An updated Cochrane review has evaluated the benefits and harms of abdominal drainage after open or laparoscopic appendectomy in children and adults.

Main results: 8 RCTs and quasi-RCTs with 739 participants were included. All studies assessed complications among participants receiving a drain versus those not receiving a drain. Six studies published between 1973 and 2011 assessed complications after open appendectomy in children and adults, and two studies published in 2022 and 2023 assessed complications in children after laparoscopic appendectomy.

Mortality

• Abdominal drainage probably increases the odds of mortality compared with no drainage in children and adults undergoing open appendectomy for complicated appendicitis. The anticipated risk within the first 30 days after the operation was 17 deaths per 1,000 participants receiving drainage (95% CI 4 to 65) versus 3 per 1,000 receiving no drainage (6 studies, 581 participants).

Intraperitoneal abscess, wound infection, morbidity, and the length of hospital stay

• Using a drain or not has little to no effect on these outcomes, but the evidence is very uncertain.

Authors' conclusion: The evidence is very uncertain whether abdominal drainage prevents intraperitoneal abscess, wound infection, or morbidity in paediatric and adult participants undergoing open or laparoscopic appendectomy for complicated appendicitis. Consequently, there is no evidence of any clinical improvement with the use of abdominal drainage in these participants. The increased risk of mortality with drainage is based on eight deaths observed in paediatric and adult participants undergoing open appendectomy for complicated appendicitis. Larger studies are needed to more reliably determine the effects of drainage on mortality outcomes.

Access the publication here: https://doi.org/10.1002/14651858.CD010168.pub5