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. 2025 Sep 11;17(9):e92097.
doi: 10.7759/cureus.92097. eCollection 2025 Sep.

Outcomes of the Use of Pelvic Drain Post-laparoscopic Appendicectomy for Complicated Appendicitis: A Two-Year Single Centre Audit Experience

Arafa Bakr  1 , James Tsejime  1 , Ellie Herniman  1 , Monique J Lucas  1 , Chenai Mandangu  1 , Quadri A Sanni  2 , Sameh Fahmy  1
Affiliations

Outcomes of the Use of Pelvic Drain Post-laparoscopic Appendicectomy for Complicated Appendicitis: A Two-Year Single Centre Audit Experience

Arafa Bakr et al. Cureus. .

Abstract

Introduction: Complicated appendicitis is defined as perforated appendicitis, periappendicular abscess, or peritonitis (acute inflammation of the peritoneum secondary to infection of the appendix). The use of pelvic drains in patients undergoing laparoscopic appendicectomy for complicated appendicitis emerged as a topic of considerable debate.

Aim: This audit aimed to explore local practice and the outcomes of patients undergoing laparoscopic appendicectomy for complicated appendicitis with and without the use of pelvic drains.

Methods: This retrospective audit was conducted at a district general hospital in the West Midlands, UK, between April 2022 and April 2024. All patients undergoing laparoscopic appendicectomy for complicated appendicitis were identified via theatre records, including children (≥5 years old) and adults. Cases were excluded if they were converted to open surgery or performed during another procedure.

Results: Of the patients included in the audit, 454 (94.5%) underwent laparoscopic appendicectomy, while 24 (5%) patients had open surgeries. A total of 216 (47%) patients had intraoperatively complicated appendicitis. Among these, histology confirmed acute appendicitis in 204 (94.4%) patients, whereas 8 (3.7%) patients had a normal appendix and 2 (0.9%) patients had adenocarcinoma. About 84 (39%) patients had a pelvic drain placed, while 132 (61%) patients did not have a drain. The average hospital stay for patients with drains was 5.2 days (SD ±3.8), compared with 2.7 days (SD ±2.2) for those without drains. Around 13% of patients with drains were readmitted, and 6 (7%) patients developed postoperative collections. In comparison, 52% of patients without drains were readmitted, and 27 (20%) of these had postoperative collections.

Conclusion: The use of pelvic drains can be a cause of significant morbidity for patients; however, case-by-case patient selection is needed to ensure improved outcomes.

Keywords: audit cycle; complicated acute appendicitis; open and laparoscopic surgery; patient outcome research; pelvic drain; surgery general.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. South Warwickshire University NHS Foundation Trust issued approval SWFT-2425-055. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Gender distribution of patients with complicated appendicitis
N=216
Figure 2
Figure 2. Age distribution of patients with complicated laparoscopic appendectomy
Mean age: 29 ± 21.2 years
Figure 3
Figure 3. Postoperative complications in the cohort of patients who did not have drain insertion
FP, Free pus; GA, Gangrenous appendix; IR, Interventional radiology; PA, Perforated appendix
Figure 4
Figure 4. Postoperative complications in the cohort of patients who had initial drain insertion
FP, Free pus; GA, Gangrenous appendix; IR, Interventional radiology; PA, Perforated appendix
Figure 5
Figure 5. Outcomes of drain insertion versus non-drain insertion
IR, Interventional radiology
See this image and copyright information in PMC

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