Routine Abdominal Drain Not Recommended After Laparoscopic Appendectomy for Perforated Appendicitis: Study

Written By : Dr. Shravani Dali Published On 2025-10-13T20:30:44+05:30 | Updated On 13 Oct 2025 8:31 PM IST

Researchers have found in a new study published in BMC Surgery by Hao Lu, Shikuan Li, Dawei Zhang, Shengqiang Wang, Hairui Liu, Chengzhi Wang, and Honghao Peng that there was no clear advantage to routine abdominal drain placement in adults undergoing laparoscopic appendectomy for perforated appendicitis. The authors report that across matched patient groups, use of a drain was associated with longer operative time, extended antibiotic courses, and longer hospital stay, but did not reduce surgical site infection rates. Their findings support current guideline trends that discourage routine drainage, while noting that further multicenter randomized controlled trials are needed for definitive confirmation.

The investigators retrospectively reviewed clinical data from adult patients treated between 2019 and 2024 at Qingdao University’s affiliated hospital, distinguishing those who received an abdominal drain during surgery from those who did not. They applied propensity score matching to balance baseline characteristics and reduce confounding. After matching, both groups showed similar rates of surgical site infection, indicating no statistically significant benefit from drainage in preventing postoperative infection. On the flip side, the drain group demonstrated longer durations of postoperative antibiotic use, longer hospital stays, and greater operative time. The odds ratio for surgical site infection in drain versus non-drain groups was essentially neutral.

What this really means is that placing an abdominal drain routinely in cases of perforated appendicitis undergoing laparoscopic surgery may be unnecessary and potentially burdensome without improving outcomes. The added operative time, prolonged antibiotic exposure, and extended hospital stay raise concerns about increased costs and potential risks without clear infection prevention benefit. But the authors rightly caution that their work is retrospective and single center, and that patient populations with greater severity of infection may respond differently. They call for prospective, multicenter randomized studies to validate whether omitting drainage is safe and effective across broader clinical settings. Published in BMC Surgery, this study reinforces a growing movement against routine drainage in minimally invasive appendiceal surgery.

Keywords: Abdominal drain, Laparoscopic appendectomy, Perforated appendicitis, Propensity score matching, Surgical site infection, BMC Surgery, Hao Lu, Drain placement, Postoperative outcomes

Reference:

Lu, H., Li, S., Zhang, D., Wang, S., Liu, H., Wang, C., & Peng, H. (2025). Effect of abdominal drain on surgical site infection undergoing laparoscopic appendectomy for perforated appendicitis in adults: a propensity score matching analysis. BMC Surgery, 25, Article 470.

Abdominal drainLaparoscopic appendectomyPerforated appendicitisPropensity score matchingSurgical site infectionBMC SurgeryDrain placementPostoperative outcomes

Source : BMC Surgery

Dr. Shravani Dali

Dr. Shravani Dali has completed her BDS from Pravara institute of medical sciences, loni. Following which she extensively worked in the healthcare sector for 2+ years. She has been actively involved in writing blogs in field of health and wellness. Currently she is pursuing her Masters of public health-health administration from Tata institute of social sciences. She can be contacted at editorial@medicaldialogues.in.