ROUTINE DRAINAGE IN COMPLICATED APPENDICITIS: PROTECTIVE STRATEGY OR OUTDATED PRACTICE? saramburu@hospitalaleman.com

PW03-11

ROUTINE DRAINAGE IN COMPLICATED APPENDICITIS: PROTECTIVE STRATEGY OR OUTDATED PRACTICE?

6

Argentina

Oral only

Complicated acute appendicitis (CAA), defined as gangrenous or perforated with peritonitis, carries high postoperative morbidity, often with intra-abdominal abscess. This study assesses the controversial role of drainage in preventing abscess after laparoscopic appendectomy for CAA.

Retrospective analysis (2005–2025) of laparoscopic appendectomies for CAA. Patients were divided into drainage (DG) and no-drainage groups (NDG). Demographic, surgical, and postoperative variables were compared.

Of 2857 laparoscopic appendicectomy, 646 (22.6%) were for CAA. 179 (27.7%) belonged to DG and 467 (72.3%) to NDG. Patients in DG were older (DG: 50.3 vs NDG: 41.8 years, p<0.005), had higher CRP levels (DG: 144.9 vs NDG: 81.6, p<0.005), and higher obesity rates (BMI >30, p=0.02). CT imaging was more frequently used in DG (56% vs 32%, p<0.005), and a higher proportion were classified as ASA II (p=0.001). Operative time was longer in DG (94 vs 69.6 minutes, p<0.005), with a higher incidence of peritonitis (85% vs 79%, p=0.05). Postoperatively, DG patients had longer hospital stays (5.28 vs 2.89 days, p<0.005), more surgical site infections (7.8% vs 2.35%, p=0.02), and a higher rate of Clavien-Dindo grade IV complications (2% vs 0%, p=0.03). No differences were observed in overall morbidity, readmission, or intraperitoneal abscesses. There was no mortality in the series.

Drainage did not reduce intraperitoneal abscess, readmission, or overall complications, but was associated with longer hospital stay and more surgical site infections. Routine drainage after laparoscopic appendectomy for CAA appears unnecessary, as it offers no protective benefit and may increase postoperative morbidity.