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Review
. 2022 Nov 29;14(11):e32018.
doi: 10.7759/cureus.32018. eCollection 2022 Nov.

Evaluation of Drain Insertion After Appendicectomy for Complicated Appendicitis: A Systematic Review and Meta-Analysis

Abduelraheim Abu  1 , Ali Yasen Mohamedahmed  2 , Amin Alamin  3 , Mazin Mohamed  4 , Mohamed Osman  5 , Mohammed Jibreel Mohammed  6 , Hiba Abdalla  7 , Hazim A Eltyeb  8 , Omer Ali  9 , Rifat Mohamad  10 , Safaa Hamid  11 , Shaza Faycal Mirghani  12 , Yousif Hamad  13 , Hussam Khougali Mohamed  14
Affiliations
Review

Evaluation of Drain Insertion After Appendicectomy for Complicated Appendicitis: A Systematic Review and Meta-Analysis

Abduelraheim Abu et al. Cureus. .

Abstract

This meta-analysis aims to evaluate the comparative outcomes of drain insertion versus no drain after appendicectomy for complicated appendicitis. A systematic search of PubMed, Cochrane Library and Scopus was conducted, and all studies comparing drain versus no drain after appendicectomy for complicated appendicitis were included. Abdominal collection, surgical site infection (SSI), bowel obstruction, faecal fistula, paralytic ileus, length of hospital stay (LOS) and mortality were the evaluated outcome parameters for the meta-analysis. Seventeen studies reporting a total number of 4,255 patients who underwent appendicectomy for complicated appendicitis with (n=1,580) or without (n=2,657) drain were included. There was no significant difference between the two groups regarding abdominal collection (odds ratio (OR)=1.41, P=0.13). No-drain group was superior to the drain group regarding SSI (OR=1.93, P=0.0001), faecal fistula (OR=4.76, P=0.03), intestinal obstruction (OR=2.40, P=0.04) and paralytic ileus (OR=2.07, P=0.01). There was a difference regarding mortality rate between the two groups (3.4% in the drain group vs 0.5% in the no-drain group, risk difference (RD)=0.01, 95% CI (-0.01, 0.04), P=0.36). In conclusion, this meta-analysis has shown that drains have no effect on the development of intra-abdominal collections in complicated appendicitis, but it can significantly increase the risk of postoperative complications such as fistula, surgical site infection (SSI), bowel obstruction, ileus and length of hospital stay.

Keywords: drain insertion; intra-abdominal abscess; intra-abdominal collection; postoperative ileus; ruptured appendicitis.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Risk of bias summary of included RCTs.
RCT: randomized control trial.
Figure 2
Figure 2. Risk of bias graph of included RCTs.
RCT: randomized control trial.
Figure 3
Figure 3. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart.
Figure 4
Figure 4. Forest plot of abdominal collection.
DG: drain group, NDG: no-drain group, M-H: Mantel-Haenszel.
Figure 5
Figure 5. Forest plot of subgroup analysis for open and laparoscopic appendicectomy.
DG: drain group, NDG: no-drain group, M-H: Mantel-Haenszel.
Figure 6
Figure 6. Forest plot of the subgroup for paediatrics-only studies.
DG: drain group, NDG: no-drain group, M-H: Mantel-Haenszel.
Figure 7
Figure 7. Forest plot of surgical site infection.
DG: drain group, NDG: no-drain group, M-H: Mantel-Haenszel.
Figure 8
Figure 8. Forest plot of faecal fistula.
DG: drain group, NDG: no-drain group, M-H: Mantel-Haenszel.
Figure 9
Figure 9. Forest plot of bowel obstruction.
DG: drain group, NDG: no-drain group, M-H: Mantel-Haenszel.
Figure 10
Figure 10. Forest plot of paralytic ileus.
DG: drain group, NDG: no-drain group, M-H: Mantel-Haenszel.
Figure 11
Figure 11. Forest plot of length of hospital stay.
DG: drain group, NDG: no-drain group, M-H: Mantel-Haenszel.
Figure 12
Figure 12. Forest plot of mortality.
DG: drain group, NDG: no-drain group, M-H: Mantel-Haenszel.
See this image and copyright information in PMC

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