title: Peritoneal lavage versus drainage for perforated appendicitis in children Is peritoneal drainage necessary in childhood perforated appendicitis?--a comparative study. Abdominal Drainage Following Appendectomy and Cholecystectomy Peritoneal drainage and systemic antibiotics after appendicectomy. A prospective trial. Literature searching for randomized controlled trials used in Cochrane reviews: rapid versus exhaustive searches. Management strategy for dirty abdominal incisions: primary or delayed primary closure? A randomized trial. Incidence of Acute Nonperforated and Perforated Appendicitis: Age-specific and Sex-specific Analysis A perforated appendix: should we drain? The utility of peritoneal drains in children with uncomplicated perforated appendicitis Should you drain a perforated appendix? Wound infection following appendicectomy: The effect of extraperitoneal wound drainage and systemic antibiotic prophylaxis
abstract: A total of 231 children with acute appendicitis were treated at our hospitals during the 10 years between 1984 and 1993 , 53 of whom had a perforated appendix . These 53 patients were r and omly assigned to two groups at the time of surgery according to the different procedures performed . Thus , 29 children were managed by appendectomy followed by peritoneal lavage using a large amount of saline , and intravenous antibiotic therapy consisting of aminoglycoside and cephem ( lavage group ) , while the other 24 children were treated by appendectomy with silicon tube drainage and the same systemic antibiotic therapy ( drainage group ) . The mean length of hospitalization , and the mean duration s of fever and the need for fasting after laparotomy in the lavage group were significantly less than those in the drainage group : 10.1 versus 18.8 days , 2.8 versus 7.7 days , and 1.8 versus 3.5 days , respectively . The operation wounds healed well in the lavage group due to the fact that there was no drain . Wound infections occurred in two children from the lavage group and six from the drainage group . Intra-abdominal abscesses occurred in two children from the drainage group . Accordingly , peritoneal lavage appears to be superior to intraperitoneal tube drainage for the management of perforated appendicitis in children PURPOSE / BACKGROUND In this study , we aim ed to evaluate the effect of peritoneal drainage ( PD ) on postoperative infective complications in cases with perforated appendicitis . METHOD One hundred nine patients ( with PD ) were evaluated retrospectively and 117 cases ( with no drainage [ ND ] ) were evaluated prospect ively regarding complications like wound infection ( WI ) , intraabdominal abscess ( IAA ) , and small bowel obstruction caused by adhesions ( SBO ) in perforated appendicitis cases . The abdomen was irrigated with isotonic NaCl solution and the wounds were closed primarily in all patients . RESULTS The total number of patients was 226 ( male , 66.4 % ; female , 33.6 % ) , with a mean age of 8.6 + /- 3.4 years ( range , 1 - 15 years ) . The WI rates in PD and ND groups were 28.4 % to 16.2 % , respectively . The ratio of IAA in the PD group was 12.8 % which decreased to 3.4 % in the ND group . The difference was statistically significant ( P < .05 ) . The postoperative hospitalization period in the PD and ND groups were 10.2 + /- 6.5 and 8.3 + /- 3.3 days , duration s of antibiotic use were 9.5 + /- 5.5 and 7.7 + /- 2.7 days , duration s of NG tube usage were 3.2 + /- 1.5 and 2.2 + /- 1.2 days , time to oral feeding was 3.7 + /- 1.7 and 2.5 + /- 1.4 days , and time to normalization of the body temperatures was 3.7 + /- 2.3 vs 2.3 + /- 1.7 days . All differences were statistically significant ( P < .05 ) . The ratio of SBO increased from 2.8 % to 3.4 % in the ND group , but this result was not statistically significant . CONCLUSIONS As a result of this study , we recommend that peritoneal drainage should be ab and oned in childhood appendicitis Consecutive patients undergoing emergency appendectomy ( 283 ) or urgent cholecystectomy ( 51 ) were prospect ively studied for the development of postoperative incisional or peritoneal sepsis . Severity of the original peritoneal infection was carefully recorded , while use of a Penrose dam to drain the peritoneum was r and omized according to pre-assigned hospital number . Both aerobic and anaerobic cultures were taken from the abdomen at the time of operation as well as from all postoperative infectious foci . Results demonstrated no essential differences in incidence of wound and peritoneal infection following  appendectomy  for simple or suppurative appendicitis ( 187 ) or following  cholecystectomy  for acute cholecystitis ( 51 ) . However , with gangrenous or perforative appendicitis ( 94 ) , incisional and intra-abdominal infection rates were 43 % and 45 % , respectively , when a drain was used ; yet only 29 and 13 % , respectively , without a drain . These latter differences were significant ( p < 0.001 ) . In addition , intra-abdominal abscesses were three times as likely to drain through the incision than along any tract provided by the rubber conduit . Cultures revealed that hospital pathogens accounted for a greater proportion of wound and peritoneal sepsis after cholecystectomy and appendectomy for simple or suppurative appendicitis if a drain had been inserted than if managed otherwise . By contrast , a mixed bacterial flora was responsible for most infections following appendectomy for gangrenous or perforated appendicitis , irrespective as to use of a drain Abstract A prospect i ve , r and omised clinical trial has been carried out to determine the effects of peritoneal drainage or prophylactic systemic antibiotics on infection after emergency appendicectomy . 329 patients were included . Drainage increased the number of days of postoperative fever significantly ( OBJECTIVES To analyze sources search ed in Cochrane review s , to determine the proportion of trials included in review s that are indexed in major data bases , and to compare the quality of these trials with those from other sources . METHODS All new systematic review s in the Cochrane Library , Issue1 2001 , that were restricted to r and omized controlled trials ( RCTs ) or quasi- RCTs were selected . The sources search ed in the review s were recorded , and the trials included were checked to see whether they were indexed in four major data bases . Trials not indexed were checked to determine how they could be identified . The quality of trials found in major data bases was compared with those found from other sources . RESULTS The range in the number of data bases search ed per review ranged between one and twenty-seven . The proportion of the trials in the four data bases were Cochrane Controlled Trials Register = 78.5 % , MEDLINE = 68.8 % , Embase = 65.0 % , and Science/Social Sciences Citation Index = 60.7 % . Search ing another twenty-six data bases after Cochrane Controlled Trials Register ( CCTR ) , MEDLINE , and Embase only found 2.4 % additional trials . There was no significant difference between trials found in the CCTR , MEDLINE , and Embase compared with other trials , with respect to adequate allocation concealment or sample size . CONCLUSIONS There was a large variation between review s in the exhaustiveness of the literature search es . CCTR was the single best source of RCTs . Additional data base search ing retrieved only a small percentage of extra trials . Contacting authors and manufacturers to find unpublished trials appeared to be a more effective method of obtaining the additional better quality trials BACKGROUND AND PURPOSE It is still a matter of debate whether delayed primary closure ( DPC ) of dirty abdominal incisions reduces surgical site infections ( SSIs ) compared with primary closure ( PC ) . Our objective was to determine whether DPC of dirty abdominal incisions reduces SSIs . METHOD A controlled r and omized study was conducted at an academic tertiary care 1,500-bed university hospital in Western India involving 81 consecutive patients with dirty abdominal incisions . Only 77 patients ( DPC = 37 , PC = 40 ) were evaluable because of the deaths of four patients . A total of 52 patients had peptic or typhoid perforations , whereas the rest had appendicular perforations/abscesses , penetrating or blunt abdominal injuries with gastrointestinal perforation , or intra-peritoneal abscesses . Patients were r and omized to have their surgical incisions ( skin and subcutaneous tissue ) either closed primarily ( PC ) or left open with saline-soaked gauze dressings for DPC on the 3(rd ) postoperative day or later if the incision conditions were inappropriate for closure . The main outcome measure was the incidence of postoperative SSI . RESULTS In the entire series , SSI developed after incision closure in 23 % of the patients . Infections were significantly more common in the PC group ( 42.5 % vs. 2.7 % for DPC ; p = 0.0000375 ) . There also were significantly more cases of abdominal dehiscence in the PC group ( DPC 1 [ 2.7 % ] vs. PC 10 [ 25 % ] ; p = 0.005 ) . The mean complete incision healing ( CIH ) time and length of hospital stay ( LOS ) were longer after PC ( 18.52 days ) than DPC ( 13.86 days ) , result ing in a significant difference in the end point of healing and LOS ( p = 0.0207 ) . Short-term cosmetic results for PC incisions were significantly inferior to those for DPC ( p = 0.03349 ) . CONCLUSIONS Delayed primary closure is a sound incision management technique that should be utilized for dirty abdominal incisions . It significantly lowers the rate of superficial SSI as well as fascial dehiscence and reduces the mean CIH time and hospitalization . The short-term cosmetic appearance is superior Abstract . This prospect i ve study was performed to investigate epidemiological characteristics in terms of the age- and sex-specific incidence in patients with perforated and nonperforated appendicitis . The study population comprised 1486 consecutive patients who underwent appendectomy for suspected acute appendicitis between 1989 and 1993 . Two patient cohorts [ n = 544 ( 37 % ) ] were analyzed with regard to prehospitalization duration of symptoms and in-hospital observation time . The crude incidence of acute appendicitis was 86 per 100,000 per year . Although the incidence of nonperforated appendicitis was highest among adolescents and young adults ( 13–40 years of age ) , perforated appendicitis occurred at almost the same incidence in all sex and age groups . The diagnostic accuracy was 76 % . Perforated appendicitis occurred in 19 % , with higher rates in small children and the elderly , irrespective of gender . A high diagnostic accuracy was not associated with an increased rate of perforation . In small children and the elderly , the diagnostic accuracy was low and the perforation rate high . Patients with perforation had a significantly longer duration of symptoms as well as in-hospital observation time than did patients with nonperforated appendicitis . Perforated appendicitis showed a different incidence pattern than nonperforated appendicitis and was associated with a significantly longer duration of symptoms and in-hospital observation time , probably due to patient-related factors . We suggest this observation deserves attention regarding clinical diagnosis and treatment decision-making for patients with suspected acute appendicitis The effectiveness of intraperitoneal drain was studied on patients undergoing appendicectomy for perforated appendicitis . R and omly 40 patients were allocated with drainage by corrugated rubber drains  and 46 patients were without drainage .  There were 5 deaths in the series , out of which 4 ( 10 % ) were in the drainage group and one ( 2.2 % ) in the group without drainage . The incidences of major wound sepsis , paralytic ileus , intraperitoneal abscess and urinary infection were observed in 55 % , 42.5 % , 12.5 % and 15 % respectively in drainage group and 50 % , 28.3 % , 21.7 % and 15.2 % respectively in non-drainage group . Occurrence of subphrenic abscess ( 7.5 % ) , burst abdomen ( 5 % ) and faecal fistula ( 5 % ) were confined to drainage group only Peritoneal drainage in children with uncomplicated perforated appendicitis ( UPA ) is still controversial . Many pediatric surgeons prefer not to drain the peritoneal cavity in such cases . However , there is no r and omized controlled study performed in children . We aim ed to study the effects of peritoneal drainage in children with UPA in a r and omized prospect i ve trial . One hundred and forty consecutive patients with UPA were divided r and omly into 2 groups . Group I ( 70 patients ) consisted of cases with peritoneal drainage , and group II ( 70 patients ) without drainage . UPA is defined as perforated appendicitis with no more discoloration of peritoneal fluid after peritoneal wash out . Cases with localized abscess in the peritoneum were excluded from the study . In all patients , the ages , duration of symptoms , nasogastric drainage and hospitalization , and complications after surgery were recorded . The duration of hospitalization and nasogastric draining time were significantly lower in patients without peritoneal drainage . There was no difference in postoperative complications between the two groups . The onset of oral intake after surgery was significantly earlier in group II patients . Placing drains in the peritoneum does not improve outcome in UPA . Therefore , we do not recommend routine drainage of children with UPA One hundred and three consecutive patients undergoing appendicectomy for perforated appendicitis were r and omly allocated either to have an intraperitoneal drain inserted or not . The results of this trial lend no support to the advocates of drainage The value of extraperitoneal wound drainage and a 3‐day course of prophylactic systemic cephaloridine used both separately and together have been assessed in a prospect i ve controlled r and omized trial involving 246 patients undergoing appendicectomy at the Leicester Royal Infirmary .  Extraperitoneal wound drainage was shown to reduce significantly the incidence of post‐operative wound infection in patients with a gangrenous or perforated appendix ( P<0·025 ) . Prophylactic cephaloridine significantly reduced the overall incidence of wound infection ( P<0·02 ) and was also effective when the appendix was gangrenous or perforated ( P<0·01 ) . A highly significant reduction in wound infection was achieved when the appendix was gangrenous or perforated by the addition of wound drainage to the antibiotic regimen ( P<0·001 )
target: There were no significant differences between the two groups in the rates of intra-peritoneal abscess or wound infection .
  It is not clear whether routine abdominal drainage has any effect on the prevention of intra-peritoneal abscess after open appendectomy for complicated appendicitis .
  Abdominal drainage after an emergency open appendectomy may be associated with delayed hospital discharge for patients with complicated appendicitis
background: BACKGROUND Appendectomy , the surgical removal of the appendix , is performed primarily for acute appendicitis .
  Patients who undergo appendectomy for complicated appendicitis , defined as gangrenous or perforated appendicitis , are more likely to suffer from postoperative complications .
  The routine use of abdominal drainage to reduce postoperative complications after appendectomy for complicated appendicitis is controversial .
  OBJECTIVES To assess the safety and efficacy of abdominal drainage to prevent intra-peritoneal abscess after open appendectomy for complicated appendicitis .