Intraperitoneal drains during open appendicectomy for gangrenous and perforated appendicitis

Table 1 Comparative studies analyzing the effects of drainage vs non drainage in open appendicectomies conducted for perforated and gangrenous appendix

Ref.	Year	Country	Type of study	Type of appendix	Treatment	Patients (n)	Antibiotic regimen	Abdominal abscess	Postoperative ileus	Surgical site infections	Wound dehiscence	Adhesions	Fecal fistula	Burst abdomen	Mortality
Everson et al[20]	1977	United Kingdom	RCT	PR/GA	D	14	Cephaloridine 1gr QDS - 3 d coverage	-	-	3 (21)	-	-	-	-	-
					ND	16	Cephaloridine 1gr QDS - 3 d coverage	-	-	6 (38)	-	-	-	-	-
Greenall et al[11]	1978	United Kingdom	RCT	PR	D	48	(various antibiotics)	7 (15)	18 (38)	34 (71)	-	-	2 (4)	3 (6)	3 (6)
					ND	55	(various antibiotics)	12 (22)	12 (22)	38 (69)	-	-	0 (0)	0 (0)	1 (2)
MacKellar et al[12]	1986	Australia	Retros.	PR/GA	D	19	Metronidazole ± Gentamycin and Ampicillin (if suspected peritonitis)	1 (5)	-	3 (16)	-	-	-	-	-
					ND	139	Metronidazole ± Gentamycin and Ampicillin (if suspected peritonitis)	2 (1)	-	2 (1)	-	-	-	-	-
Samelson et al[13]	1987	United States	Retros.	PR	D	24	Ampicillin, Gentamycin and Clindamycin if suspected perforation for 7-10 d	3 (13)	-	-	-	-	-	-	-
					ND	170	Ampicillin, Gentamycin and Clindamycin if suspected perforation for 7-10 d	3 (2)	-	-	-	-	-	-	-
Dandapat et al[14]	1992	India	RCT	PR	D	40	-	8 (20)	17 (43)	22 (55)	-	-	2 (5)	2 (5)	4 (10)
					ND	46	-	10 (22)	13 (28)	23 (50)	-	-	0 (0)	0 (0)	1 (2)
Johnson et al[3]	1993	United States	Retros.	PR	D	32	-	0 (0)	5 (16)	1 (3)	-	-	-	-	-
					ND	34	-	3 (9)	3 (9)	2 (5.9)	-	-	-	-	-
Toki et al[15]	1995	Japan	RCT	PR	D	24	Aminoglycoside and Cephem	2 (8)	-	6 (25)	-	0 (0)	-	-	-
					ND	29	Aminoglycoside and Cephem	0 (0)	-	2 (7)	-	0 (0)	-	-	-
Perović et al[19]	2000	Croatia	Retros.	PR	D	20	-	-	4 (20)	13 (65)	2 (10)	-	-	-	-
					ND	36	-	-	1 (3)	7 (19)	2 (6)	-	-	-	-
Narci et al[16]	2007	Turkey	Retros.	PR	D	109	-	14 (13)	-	31 (28)	-	3 (3)	-	-	-
					ND	117	-	4 (3)	-	19 (16)	-	4 (3)	-	-	-
Jani et al[17]	2011	Kenya	RCT	PR	D	45	Cefuroxime and Metronidazole or Penicillin, Gentamicin and Metronidazole or Amoxicillin-Clavulanate and Metronidazole	3 (7)	1 (2)	15 (33)	-	-	2 (4)	-	-
					ND	45	Cefuroxime and Metronidazole or Penicillin, Gentamicin and Metronidazole or Amoxicillin-Clavulanate and Metronidazole	0 (0)	0 (0)	3 (7)	-	-	0 (0)	-	-
Akkoyun et al[18]	2012	Turkey	Retros.	PR	D	61	-	3 (5)	5 (8)	3 (5)	1 (2)	1 (2)	-	-	-
					ND	173	-	3 (2)	4 (2)	3 (2)	0 (0)	1 (1)	-	-	-
Al-Shahwany et al[21]	2012	Iraq	RCT	PR	D	46	Ceftriaxone and Metronidazole	-	-	18 (39)	-	-	0 (0)	-	0 (0)
					ND	38	Ceftriaxone and Metronidazole	-	-	14 (37)	-	-	0 (0)	-	0 (0)
Total					D	482		39/378 (10.3)	50/246 (20.3)	149/458 (32.5)	3/81 (3.7)	4/194 (2)	6/179 (3.4)	5/88 (5.7)	7/134 (5.2)
					ND	862		37/779 (4.7)	33/389 (8.5)	112/692 (16.2)	2/209 (0.95)	5/319 (1.6)	0/184 (0)	0/101 (0)	2/139 (1.4)
Power calculation								80%	95%	99%	1%	0.02%	99%	99%	99%
odds ratio								2.2	2.4	2	3.9	1.3	-1	-1	3.7
P value (D vs ND)								< 0.0001	< 0.0001	< 0.0001	0.11 (NS)	0.68 (NS)	0.01	0.01	0.08 (NS)

¹Although the incidence was higher in the drain vs non drain group, the odds ratio could not be formally calculated for this complication because of the lack of occurrences in the latter. PR: Perforated appendix; GA: Gangrenous appendix; D: Drainage; ND: Non drainage; RCT: Retrospective randomised trial; Retros.: Retrospective; UTI: Urinary tract infections; QDS: Every 6 h.