PERFORATED APPENDICITIS IN CHILDREN - TO DRAIN OR NOT TO DRAIN

We studied 66 children with perforated appendicitis at the University of New Mexico to determine whether or not transperitoneal drainage has any advantage in the management of these children. Patients were assi gned to one or the other treatment group on the basis of the call sche dule of the attending surgeons, two of whom preferred drainage and two of whom did not. Other aspects of appendicitis management (e.g., supp ortive care, antibiotics) were the same for both groups. Thirty-two ot her children who had an abscess at the time of appendectomy were exclu ded from the analysis. The two study groups were similar in age and se verity of illness. Postoperative complications (wound infection, abdom inal abscess, small-bowel obstruction) had a similar incidence in the two groups: 6/32 (18.8%) for the drained group and 7/34 (20.6%) for th e undrained group. The hospital stay was significantly longer for the drained group (mean 10.1 days, median 9 days) versus the undrained gro up (mean 7.0 days, median 7 days). The power of our study was 0.52; tw ice our sample size would have been required to achieve a power of 0.8 0. The evidence suggests that, unless an abscess is present, drainage may be abandoned for children with perforated appendicitis.