Abstract
INTRODUCTION: Complicated appendicitis is defined as perforated appendicitis, periappendicular abscess, or peritonitis (acute inflammation of the peritoneum secondary to infection of the appendix). The use of pelvic drains in patients undergoing laparoscopic appendicectomy for complicated appendicitis emerged as a topic of considerable debate. AIM: This audit aimed to explore local practice and the outcomes of patients undergoing laparoscopic appendicectomy for complicated appendicitis with and without the use of pelvic drains. METHODS: This retrospective audit was conducted at a district general hospital in the West Midlands, UK, between April 2022 and April 2024. All patients undergoing laparoscopic appendicectomy for complicated appendicitis were identified via theatre records, including children (≥5 years old) and adults. Cases were excluded if they were converted to open surgery or performed during another procedure. RESULTS: Of the patients included in the audit, 454 (94.5%) underwent laparoscopic appendicectomy, while 24 (5%) patients had open surgeries. A total of 216 (47%) patients had intraoperatively complicated appendicitis. Among these, histology confirmed acute appendicitis in 204 (94.4%) patients, whereas 8 (3.7%) patients had a normal appendix and 2 (0.9%) patients had adenocarcinoma. About 84 (39%) patients had a pelvic drain placed, while 132 (61%) patients did not have a drain. The average hospital stay for patients with drains was 5.2 days (SD ±3.8), compared with 2.7 days (SD ±2.2) for those without drains. Around 13% of patients with drains were readmitted, and 6 (7%) patients developed postoperative collections. In comparison, 52% of patients without drains were readmitted, and 27 (20%) of these had postoperative collections. CONCLUSION: The use of pelvic drains can be a cause of significant morbidity for patients; however, case-by-case patient selection is needed to ensure improved outcomes.