Prevention of infectious complications after laparoscopic appendectomy for complicated acute appendicitis—the role of routine abdominal drainage

Allemann, Pierre; Probst, H.; Demartines, Nicolas; Schäfer, Markus

doi:10.1007/s00423-010-0709-z

Cited by 78 publications

(54 citation statements)

References 32 publications

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“…These results are consistent with recent retrospective studies [1,3,7,8,10,14], and, therefore, LA for CA is considered safe and feasible with improvements in techniques and devices. Nonetheless, the roles of extensive irrigation and routine drainage to reduce risks of IAA that were employed in this study remain debatable [22][23][24][25][26].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic versus open surgery for complicated appendicitis in adults: a randomized controlled trial

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Laparoscopic versus open surgery for complicated appendicitis in adults: a randomized controlled trial

et al. 2015

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“…However, these studies did not show the relationship of peritoneal drainage with peritoneal irrigation, while we could further demonstrate how peritoneal drainage would be beneficial when it is consequently applied after peritoneal irrigation. A recent metaanalysis reported that neither simple nor a gangrenous nor a perforated appendicitis benefit from the routine use of prophylactic drainage and that, furthermore, drainage did not reduce postoperative complications [23][24][25] . In addition, the use of routine drainage in contaminated and infected abdominal surgery is declining [26] .…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Postoperative Intra-Abdominal Abscess after Laparoscopic Appendectomy: Analysis for Consecutive 1,817 Experiences

et al. 2015

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Background: Possible risk factors for postoperative intra-abdominal abscess (IAA) formation after laparoscopic appendectomy (LA) remain controversial. A perforated appendicitis, diabetes mellitus, peritoneal irrigation, obesity and age are considered to be possible risk factors for postoperative IAA, but the existing evidence is insufficient. This study aimed to identify the risk factors for IAA formation in patients receiving LA. Methods: Between January 2010 and December 2013, 1,817 patients who underwent 3-port LA were enrolled in this study. Patients were classified into 2 groups according to the development of postoperative IAA, and the differences between the groups were analyzed. Results: The incidence of IAA after LA was 1.5%, and the only identified risk factor for IAA was peritoneal irrigation. On logistic regression analysis of those patients who received peritoneal irrigation, suppurative appendicitis and non-placement of the peritoneal drain were found to be significant risk factors for the development of IAA. Conclusions: Peritoneal irrigation in a case of abdomen contamination was shown to be a risk factor for the development of postoperative IAA after LA. When peritoneal irrigation is performed, surgeons should consider using peritoneal drainage and postoperative antibiotics (including anti-anaerobic antibiotics) to prevent postoperative IAA formation.

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“…Die Indikationsstellung zur Drainageneinlage sollte jedoch befundabhängig erfolgen. Beispielsweise scheint eine systematische Drainageneinlage bei der perforierten Appendizitis nachteilig zu sein [2]. Falls nach gründlicher Lavage eine makroskopische Verschmutzung verbleibt, können zusätz-lich Spüldrainagen zur kontinuierlichen postoperativen Lavage platziert werden.…”

Section: Prävention Persistierende/ Rezidivierende Entzündungunclassified

Chirurgische Therapie der Peritonitis

Strobel,

Werner,

Büchler

2011

Chirurg

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Despite significant progress the therapy of peritonitis remains challenging. With a mortality of up to 20% peritonitis is a predominant cause of death due to surgical infections. An early and efficient source control combined with effective antibiotic therapy and modern intensive care and sepsis therapy are definitive for the outcome and prognosis of secondary peritonitis. In approximately 90% of patients an effective source control can be achieved by one single operation with extensive peritoneal lavage. A reoperation is necessary in only about 10% of patients. The aggressive concepts of planned relaparotomy or open packing are associated with increased morbidity and are indicated only in rare cases. The gold standard is to attempt a definitive source control by one single operation. An operative revision should be performed only on demand. The antibiotic therapy should begin with a broadly calculated empirical therapy and should later be adapted to microbiological findings. The therapy of sepsis requires standardized and state of the art intensive care.

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Prevention of infectious complications after laparoscopic appendectomy for complicated acute appendicitis—the role of routine abdominal drainage

Abstract: No benefits were observed for prophylactic drainage of the abdominal cavity during emergency laparoscopic treatment of complicated appendicitis. For this reason, this practice may be abandoned.

Cited by 78 publications

References 32 publications

Laparoscopic versus open surgery for complicated appendicitis in adults: a randomized controlled trial

Laparoscopic versus open surgery for complicated appendicitis in adults: a randomized controlled trial

Risk Factors for Postoperative Intra-Abdominal Abscess after Laparoscopic Appendectomy: Analysis for Consecutive 1,817 Experiences

Chirurgische Therapie der Peritonitis

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