The value of peritoneal drains in perforated appendicitis at Kenyatta National Hospital

Abstract

Introduction Unlike simple acute appendicitis, complicated appendicitis is challenging in management and outcome unpredictable. Controversies surround some aspects of its management like the right timing and type surgical intervention, the antibiotics use and peritoneal drainage. This study focuses on use of peritoneal drains post appendectomy. Objective To evaluate the management of complicated appendicitis at Kenyatta national hospital and determine the value of peritoneal drains post appendectomy in patients with various stages of complicated appendicitis. Methodology Patients suspected to have acute appendicitis were recruited from casualty and admitting surgical wards. In theatre those with complicated acute appendicitis were stratified according to the degree of peritoneal contamination. All those with complicated acute appendicitis without generalized peritonitis were randomized to two comparison groups; drains or no drains. All patients received similar treatment in all other aspects; they were followed up for complications, duration of antibiotic use and length of hospital stay. Statistical analysis was used to compare the two groups. Results Over one year period, 216 patients were evaluated. 97 had various stages of complicated acute appendicitis, 90 were randomized. Two patients died; one of them had severe sepsis and the other developed pulmonary complications post operation. 18 patients had wound sepsis, 6 patients had other complications including fecal fistulae, abdominal abscess, and paralytic ileus. Out of those with wound sepsis, 830/0 were of the drain group and 170/0 of the no drain group. All patients with other complications were of the drain group. The patients in the drain group had significantly longer duration of antibiotic use and hospital stay. Conclusions Immediate surgical intervention, after resuscitation and with antibiotics is the main mode of management of complicated appendicitis at Kenyatta national hospital. The findings in this study do not lend any support for use of drains post appendectomy in some stages of advanced appendicitis. The management and role of drains in perforated acute appendicitis with generalized appendicitis needs further review.