Is it necessary to drain all postoperative fluid collections after appendectomy for perforated appendicitis?

Piper, Hannah G.; Derinkuyu, Betül Emine; Koral, Korgün; Pérez, Eduardo A.; Murphy, Joseph

doi:10.1016/j.jpedsurg.2011.03.043

Cited by 14 publications

(5 citation statements)

References 15 publications

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“…Recent analyses similar to ours have yielded similar results, showing longer hospital stays, but less readmission after drainage procedures [34,35]. Using volume measurements, it has been suggested that draining an abscess measuring less than 20-100 ml may not incur any additional benefits [34,35]. However, these data again come from uncontrolled retrospective studies.…”

Section: Discussionsupporting

confidence: 77%

“…In addition, the duration to abscess resolution was frequently long, reported to be a median of 18.5 days with a range of 7-60 days in one study [30]. Recent analyses similar to ours have yielded similar results, showing longer hospital stays, but less readmission after drainage procedures [34,35]. Using volume measurements, it has been suggested that draining an abscess measuring less than 20-100 ml may not incur any additional benefits [34,35].…”

Section: Discussionsupporting

confidence: 76%

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Determinants of postoperative abscess occurrence and percutaneous drainage in children with perforated appendicitis

et al. 2014

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Section: Discussionsupporting

confidence: 77%

Section: Discussionsupporting

confidence: 76%

Determinants of postoperative abscess occurrence and percutaneous drainage in children with perforated appendicitis

et al. 2014

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“…In our study, percutaneous drainage had a morbidity rate of 50%, which was similar to early laparoscopic washout. The reported mean LOS for patients undergoing percutaneous drainage for post‐appendicectomy abscess ranges from 6 to 15 days [35, 37], which is similar to our results (10.1 days). The LOS for percutaneous drainage was not significantly shorter than for early laparoscopic washout (7.0 days).…”

Section: Discussionsupporting

confidence: 89%

“…In the adult population, there are no specific data for the non‐operative treatment cohort. The mean LOS for patients treated non‐operatively is between 8 and 11 days [10, 11, 35], with larger abscesses being associated with longer LOS [35] and a higher chance of treatment failure and subsequent need for intervention [13].…”

Section: Discussionmentioning

confidence: 99%

Early Laparoscopic Washout may Resolve Persistent Intra‐abdominal Infection Post‐appendicectomy

et al. 2018

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Background Intra-abdominal abscess (IAA) complicates 2-3% of patients having an appendicectomy. The usual management is prolonged antibiotics and drainage of the IAA. From 2006, our unit chose to use early re-laparoscopy and washout in patients with persistent sepsis following appendicectomy. The aims of this study were to assess the outcomes of early laparoscopic washout in patients with features of persistent intra-abdominal sepsis and compare those with percutaneous drainage and open drainage of post-appendicectomy IAA. Methods A retrospective case note review was performed for all patients having a laparoscopic washout, percutaneous drainage or open drainage following appendicectomy between January 2006 and December 2017. Results During the period, 4901 appendicectomies occurred. Forty-one (0.8%) patients had a laparoscopic washout, 16 (0.3%) had percutaneous drainage, and 6 (0.1%) had an open drainage. The demographics, ASA grade and pathology at initial appendicectomy were similar. The mean time after appendicectomy was significantly shorter for laparoscopic washout (4.1 days vs. 10.1 and 9.0 days, p = \0.003). The mean time for resolution of SIRS was significantly shorter (2.0 days vs. 3.3 and 5.2 days, p \0.02). The morbidity and length of stay were similar. Conclusion Early laparoscopic washout for persistent intra-abdominal sepsis may be an alternative to non-operative management and delayed intervention for IAA and may have better outcomes than either percutaneous drainage or open drainage. A prospective randomised comparison is required to further evaluate the indications and role of early laparoscopic washout post-appendicectomy.

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“…4). In fact, incidental and otherwise asymptomatic findings, including fluid collections, are relatively common [8,10]. Given the frequency of fluid collections in this population, we explored the association between specific parameters such as size, enhancement, complexity, and edema and infection (Fig.…”

Section: Discussionmentioning

confidence: 99%

Fluid Collections in Amputations Are Not Indicative or Predictive of Infection

Polfer

Hoyt

Senchak

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background In the acute postoperative period, fluid collections are common in lower extremity amputations. Whether these fluid collections increase the risk of infection is unknown. Questions/purposes The purposes of this study were to determine (1) the percentage of patients who develop postoperative fluid collections in posttraumatic amputations and the natural course of the collection; (2) whether patients who develop these collections are at increased risk for infection; and to ask (3) are there objective clinical or radiologic signs that are associated with likelihood of infection when a fluid collection is present?Methods We performed a review of all 300 patients injured in combat operations who sustained at least one major lower extremity amputation (at or proximal to the tibiotalar joint) and were treated definitively at our institution between March 2005 and April 2009. We segregated the groups based on whether cross-sectional imaging was performed less than 3 months (early group) after closure, greater than 3 months (late group) after closure, or not at all (control group, baseline frequency of infection). Our primary study cohort where those patients with a fluid collection in the first three months. The clinical course was reviewed and the primary outcome was a return to the operating room for irrigation and débridement with positive cultures. For those patients with cross-sectional imaging, we also collected objective clinical parameters within 24 hours of the scan (white blood cell count, maximum temperature, presence of bacteremia, tachycardia, oxygen desaturation), extremity examination (presence of erythema, warmth, and/or drainage), and characteristics of the fluid collections seen (size of the fluid collection, Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Is it necessary to drain all postoperative fluid collections after appendectomy for perforated appendicitis?

Cited by 14 publications

References 15 publications

Determinants of postoperative abscess occurrence and percutaneous drainage in children with perforated appendicitis

Determinants of postoperative abscess occurrence and percutaneous drainage in children with perforated appendicitis

Early Laparoscopic Washout may Resolve Persistent Intra‐abdominal Infection Post‐appendicectomy

Fluid Collections in Amputations Are Not Indicative or Predictive of Infection

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