Advantages comparison of peritoneal drainage versus no drainage after laparoscopic appendectomy for complicated appendicitis: a meta-analysis
Abstract Background Peritoneal drainage (PD) following laparoscopic appendectomy(LA) has long been considered beneficial for appendicitis patients, especially those with complicated appendicitis. However, recent research has raised doubts about the advantages of PD, as it not only fails to reduce po...
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2024-11-01
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| Series: | BMC Gastroenterology |
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| Online Access: | https://doi.org/10.1186/s12876-024-03500-8 |
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| author | Hongsheng Wu Biling Liao Tiansheng Cao Tengfei Ji Yumei Luo Jianbin Huang Keqiang Ma |
| author_facet | Hongsheng Wu Biling Liao Tiansheng Cao Tengfei Ji Yumei Luo Jianbin Huang Keqiang Ma |
| author_sort | Hongsheng Wu |
| collection | DOAJ |
| description | Abstract Background Peritoneal drainage (PD) following laparoscopic appendectomy(LA) has long been considered beneficial for appendicitis patients, especially those with complicated appendicitis. However, recent research has raised doubts about the advantages of PD, as it not only fails to reduce postoperative complications but also prolongs the operative duration and hospital stay and incurs higher medical expenses. Given this controversy, we conducted a meta-analysis to determine whether drainage is necessary after LA for complicated appendicitis. This meta-analysis had registered in PROSPERO(ID: CRD42023472382). Objective This study assessed current evidence regarding the efficacy, safety, and potential benefits of drainage versus no drainage following LA for complicated appendicitis. Methods We conducted a comprehensive search of PubMed, Springer, and the Cochrane Library using the search terms “appendicitis”, “laparoscopic appendectomy”, and “drain” or “drainage” for studies published between January 1, 2000, and December 31, 2022. We employed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) criteria for study inclusion and exclusion. Primary outcomes included postoperative intra-abdominal abscess, postoperative intestinal obstruction, postoperative stump leakage, wound infection and postoperative visual analog scale(VAS) score, while secondary outcomes consisted of operative time, postoperative recovery time and total hospitalization duration. Studies with at least two outcomes were considered for meta-synthesis. Depending on I2 values, fixed- or random effects models were used for data synthesis. Pooled odds ratios (OR) and weighted mean differences (WMD) were calculated for outcome comparisons between PD and no peritoneal drainage (NPD). Sensitivity analysis and meta-regression were performed to assess and investigate inter-study heterogeneity. Results After conducting our literature search and screening, twelve studies were analyzed, comprising 3374 cases. During the comparison of primary outcomes between PD and NPD, the incidence of wound infection and postoperative VAS score were significantly higher in the PD group(P < 0.05). While during the comparison of secondary outcomes, the operative duration, postoperative recovery time and hospitalization duration were significantly longer in the PD group than in the NPD group(P < 0.05). Conclusion PD following LA for complicated appendicitis not only increases the incidence wound infection and aggravate patients’ postoperative pain, but also prolongs the operative duration, postoperative recovery time and hospitalization duration. Therefore, routine PD after LA for acute complicated appendicitis is not recommended. |
| format | Article |
| id | doaj-art-97a76acf27e84c88883cef352fb828f6 |
| institution | Kabale University |
| issn | 1471-230X |
| language | English |
| publishDate | 2024-11-01 |
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| series | BMC Gastroenterology |
| spelling | doaj-art-97a76acf27e84c88883cef352fb828f62024-11-17T12:31:16ZengBMCBMC Gastroenterology1471-230X2024-11-0124111410.1186/s12876-024-03500-8Advantages comparison of peritoneal drainage versus no drainage after laparoscopic appendectomy for complicated appendicitis: a meta-analysisHongsheng Wu0Biling Liao1Tiansheng Cao2Tengfei Ji3Yumei Luo4Jianbin Huang5Keqiang Ma6Department of Hepatobiliary Pancreatic Surgery, Huadu District People’s Hospital of GuangzhouDepartment of Hepatobiliary Pancreatic Surgery, Huadu District People’s Hospital of GuangzhouDepartment of Hepatobiliary Pancreatic Surgery, Huadu District People’s Hospital of GuangzhouDepartment of Hepatobiliary Pancreatic Surgery, Huadu District People’s Hospital of GuangzhouDepartment of Hepatobiliary Pancreatic Surgery, Huadu District People’s Hospital of GuangzhouDepartment of Hepatobiliary Pancreatic Surgery, Huadu District People’s Hospital of GuangzhouDepartment of Hepatobiliary Pancreatic Surgery, Huadu District People’s Hospital of GuangzhouAbstract Background Peritoneal drainage (PD) following laparoscopic appendectomy(LA) has long been considered beneficial for appendicitis patients, especially those with complicated appendicitis. However, recent research has raised doubts about the advantages of PD, as it not only fails to reduce postoperative complications but also prolongs the operative duration and hospital stay and incurs higher medical expenses. Given this controversy, we conducted a meta-analysis to determine whether drainage is necessary after LA for complicated appendicitis. This meta-analysis had registered in PROSPERO(ID: CRD42023472382). Objective This study assessed current evidence regarding the efficacy, safety, and potential benefits of drainage versus no drainage following LA for complicated appendicitis. Methods We conducted a comprehensive search of PubMed, Springer, and the Cochrane Library using the search terms “appendicitis”, “laparoscopic appendectomy”, and “drain” or “drainage” for studies published between January 1, 2000, and December 31, 2022. We employed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) criteria for study inclusion and exclusion. Primary outcomes included postoperative intra-abdominal abscess, postoperative intestinal obstruction, postoperative stump leakage, wound infection and postoperative visual analog scale(VAS) score, while secondary outcomes consisted of operative time, postoperative recovery time and total hospitalization duration. Studies with at least two outcomes were considered for meta-synthesis. Depending on I2 values, fixed- or random effects models were used for data synthesis. Pooled odds ratios (OR) and weighted mean differences (WMD) were calculated for outcome comparisons between PD and no peritoneal drainage (NPD). Sensitivity analysis and meta-regression were performed to assess and investigate inter-study heterogeneity. Results After conducting our literature search and screening, twelve studies were analyzed, comprising 3374 cases. During the comparison of primary outcomes between PD and NPD, the incidence of wound infection and postoperative VAS score were significantly higher in the PD group(P < 0.05). While during the comparison of secondary outcomes, the operative duration, postoperative recovery time and hospitalization duration were significantly longer in the PD group than in the NPD group(P < 0.05). Conclusion PD following LA for complicated appendicitis not only increases the incidence wound infection and aggravate patients’ postoperative pain, but also prolongs the operative duration, postoperative recovery time and hospitalization duration. Therefore, routine PD after LA for acute complicated appendicitis is not recommended.https://doi.org/10.1186/s12876-024-03500-8Peritoneal drainageLaparoscopic appendectomyComplicated appendicitisMeta-analysis |
| spellingShingle | Hongsheng Wu Biling Liao Tiansheng Cao Tengfei Ji Yumei Luo Jianbin Huang Keqiang Ma Advantages comparison of peritoneal drainage versus no drainage after laparoscopic appendectomy for complicated appendicitis: a meta-analysis BMC Gastroenterology Peritoneal drainage Laparoscopic appendectomy Complicated appendicitis Meta-analysis |
| title | Advantages comparison of peritoneal drainage versus no drainage after laparoscopic appendectomy for complicated appendicitis: a meta-analysis |
| title_full | Advantages comparison of peritoneal drainage versus no drainage after laparoscopic appendectomy for complicated appendicitis: a meta-analysis |
| title_fullStr | Advantages comparison of peritoneal drainage versus no drainage after laparoscopic appendectomy for complicated appendicitis: a meta-analysis |
| title_full_unstemmed | Advantages comparison of peritoneal drainage versus no drainage after laparoscopic appendectomy for complicated appendicitis: a meta-analysis |
| title_short | Advantages comparison of peritoneal drainage versus no drainage after laparoscopic appendectomy for complicated appendicitis: a meta-analysis |
| title_sort | advantages comparison of peritoneal drainage versus no drainage after laparoscopic appendectomy for complicated appendicitis a meta analysis |
| topic | Peritoneal drainage Laparoscopic appendectomy Complicated appendicitis Meta-analysis |
| url | https://doi.org/10.1186/s12876-024-03500-8 |
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