Prophylactic surgical drain placement with irrigation reduces abscess formation in patients with severe, uncontained, perforated appendicitis

Background 20-25% of perforated appendicitis cases are complicated by abscess formation. This study assesses whether prophylactic closed-suction surgical drain (SD) placement after irrigation can decrease postoperative abscess formation in patients with extensively contaminated, perforated appendicitis. Methods A multicenter retrospective review was performed on pediatric patients with uncontained perforated appendicitis from January 1, 2020 to August 1, 2023. Limited irrigation was performed. All SDs were oriented towards the pelvis. Data were analyzed in four groups: (G1) SD and irrigation, (G2) only SD, (G3) only irrigation, (G4) neither SD nor irrigation. Results One hundred and fifteen patients (44 in G1, 3 in G2, 21 in G3, 47 in G4) were included. The abscess rate was 5.1% (G1), 33.3% (G2), 33.3% (G3), and 37.0% (G4) (p = 0.001). No interventional radiology (IR) drains were placed in G1 and G2. SD duration was 4.1 +/- 2.1 days in G1 and 2.7 +/- 0.6 days in G2. IR drain duration was 14 +/- 10.7 days in G3 and 8.3 +/- 3.9 days in G4 (p < 0.001). There were no significant differences in total length of stay and antibiotic duration. Conclusions Irrigation with prophylactic SD placement may prevent postoperative abscesses in patients with severe, uncontained, perforated appendicitis, but prospective data are needed.