THE ROLE OF SUBCUTANEOUS NEGATIVE SUCTION DRAINS IN EXPLORATORY LAPAROTOMY FOR PERITONITIS

Dr. Vishwanath Pai, Dr. Sana Aboosalih, Dr. Dinesh Balaji, Dr. K R Manoj Prabu

Abstract


Surgical site infection (SSI) is a major problem and one of the most common complications associated with open abdominal surgery. SSI attributes to increased morbidity, mortality, healthcare costs and overall patient discomfort. The most common form of postoperative complication in emergency abdominal surgical procedure is a superficial wound infection, which occurs in the first week of surgery. The role of a subcutaneous negative pressure drain is to reduce the dead space in the subcutaneous tissue plane and there by prevent accumulation of fluid and seroma formation. In this study we observed the role of a subcutaneous negative pressure for preventing SSI following explorative laparotomy surgeries for peritonitis.

Methods:

A total of 56 patients who underwent exploratory abdominal surgical procedure, in the period between April to September 2019, were observed. The patients are divided into two groups – those treated with subcutaneous drain and those for whom subcutaneous drain was not used. The choice of using a subcutaneous drain is taken by the operating surgeon on call. Antibiotic prophylaxis was applied to each patient and the diagnosis of superficial SSI was made and was graded according to Southampton Grading System.

Results:

3 patients in drain group (27) and 14 patients in no drain group (29) had incisional SSI with statistical

difference (p<0.05). The average post operative duration of hospital stay with drain is 5-15 days and amongst those who were managed without drain the average hospital stay is 7-20 days. No statistical difference between the two groups was observed for age and gender of patients (p>0.05).

Conclusions:

Subcutaneous negative pressure drain prevents postoperative surgical site infection significantly.

Subcutaneous negative pressure drainage reduces hospital stay and thereby healthcare cost in a patient undergoing exploratory laparotomy surgery.

 


Keywords


Abdominal surgery, subcutaneous negative pressure drain, surgical site infection

Full Text:

PDF

References


Kenneth L. Mattox. Saunders Elselvier. Sabiston Text Book of Surgery. 19th Edition. 2012;2:1141.

Swanes C, Soreide JA, Soreide O, Bakke P, Vollset SE, Skarstein A. Smoking and ulcer perforation.

Gut. 1997;41:177-805.

Leaper DJ. Surgical infection. Bailey & Love’s short practice of surgery, 25th edition; 2004.

Richard T. Wound healing. Sabiston Text book of Surgery, 19th edition, 2012: 151-177.

Corman ML, Veidenheimer MC, Coller JA. Controlled clinical trial of three suture materials for

abdominal wall closure after bowel operations. Am J Surg. 1981;141:510-3.

López-Quintero L, Evaristo-Méndez G, Fuentes-Flores F, Ventura-González F, Sepúlveda-Castro R.

Treatment of open abdomen in patients with abdominal sepsis using the vacuum pack system. Cir

Cir. 2010;78(4):322-6.

Farnell MB, Worthington-Self S, Mucha P Jr, Ilstrup DM, McIlrath DC. Closure of abdominal

incisions with subcutaneous catheters. Arch Surg.1986;121:641-8.

Williams N, O’Connell PR, McCaskie A. Bailey and Love’s Short practice of surgery, 27th Edition.

: 48.

Mangram AJ, Horan TC, Pearson ML, Silver LC. Jarvis WR. Guideline for Prevention of Surgical

Site Infection. Infection Control Hospital Epidemiol. 1999;20:247-78.

Iserson KV. The man behind the ‘French ‘ gauge. J Emerg Med. 1987;5(6):545-8.

Chowdri NA, Qadri SA, Parray FQ, Gagloo MA. Role of Subcutaneous Drains in Obese Patients

Undergoing Elective Cholecystectomy:A Cohort Study. Int J Surg. 2007;5:404-7.

Fujii T, Tabe Y, Yajima R, Yamaguchi S, Tsutsumi S, Asao T, Kuwano H. Effects of Subcutaneous

Drain for the Prevention of Incisional SSI in High-Risk Patients Undergoing Colorectal Surgery. Int J

Colorectal Dis. 2011;26:1151-5.

Smith RL, Bohl JK, McElearney ST, Friel CM, Barclay MM, Sawyer RG, et al. Wound Infection

after Elective Colorectal Resection. Ann Surg. 2004;239:599-607.

Murray BW, Huerta S, Dineen S, Anthony T. Surgical Site Infection in Colorectal Surgery:A

Review of the Nonpharmacologic Tools of Prevention. J Am Coll Surgeons. 2010;211:812-22.

Hagihara M, Suwa M, Ito Y, Muramatsu Y, Kato Y,Yamagishi Y, Mikamo H. Preventing SurgicalSite

Infections after Colorectal Surgery. J Infection Chemotherp. 2012;18:83-9.

Sehgal R, Berg A, Figueroa R, Poritz LS, McKenna KJ, Stewart DB, et al. Risk Factors for Surgical Site Infections after Colorectal Resection in Diabetic Patients. J Am Coll Surgeons. 2011;212:29-34.

Malone DL, Genuit T, Tracy JK, Gannon C, Napolitano LM. Surgical Site Infections:Reanalysis

of Risk Factors. J Surgical Res. 2002;103:89-95.

Blumetti J, Luu M, Sarosi G, Hartless K, McFarlin J, Parker B, et al. Surgical Site Infections after

Colorectal Surgery: Do Risk Factors Vary Depending on the Type of Infection Considered?

Surgery. 2007;142:704-11.

Sørensen LT, Hemmingsen U, Kallehave F,Jørgensen PW, Kjærgaard J, Møller LN, et al. Risk

Factors for Tissue and Wound Complications in Gastrointestinal Surgery. Ann Surg. 2005;241:654-8.

Shaffer D, Benotti PN, Bothe A Jr, Jenkins RL, Blackburn GL. A prospective, randomized trial of

abdominal wound drainage in gastric bypass surgery. Ann Surg. 1987;206(2):134– 7.

Imada S, Noura S, Ohue M, Shingai T, Sueda T, Kishi K, et al. Efficacy of subcutaneous penrose

drains for surgical site infections in colorectal surgery. World J Gastrointest Surg. 2013;5(4):110–4.

Tochika N, Namikawa T, Kamiji I, Kitamura M, Okamoto K, Hanazaki K. Subcutaneous continuous

suction drainage for prevention of surgical site infection. J Hosp Infect. 2011;78(1):67-8.

Cardosi RJ, Drake J, Holmes S, Tebes SJ, Hoffman MS, Fiorica JV, et al. Subcutaneous management of

vertical incisions with 3 or more centimeters of subcutaneous fat. Am J Obstet Gynecol. 2006;195(2):607-14.

Baier PK, Glück NC, Baumgartner U, Adam U, Fischer A, Hopt UT.. Hopt, Subcutaneous Redon

drains do not reduce the incidence of surgical site infections after laparotomy. A randomized controlled trial on 200 patients. Int J Colorectal Dis. 2010;25(5):639-43..

Tsujita E, Yamashita Y, Takeishi K, Matsuyama A, Tsutsui S, Matsuda H, et al. Subcuticular absorbable suture with subcutaneous drainage system prevents incisional SSI after hepatectomy for hepatocellular carcinoma. World J Surg. 2012;36(7):1651-6.

Kozol RA, Fromm D, Ackerman NB, Chung R. Wound closure in obese patients. Surg Gynecol

Obstetr. 1986;162(5):442– 4.

Farnell MB, Worthington-Self S, Mucha P Jr,Ilstrup DM, McIlrath DC. Closure of abdominal

incisions with subcutaneous catheters. A prospective randomized trial. Arch Surg. 1986;121(6):641– 8.

Kagita R, Mulla SA, Pai BS, Desai M. Subcutaneous negative pressure versus simple closure of skin incision following an emergency laparotomy: a randomized control study. Int Surg J 2019;6:1230-7.

Sumi, Y. , Yamashita, K. , Kanemitsu, K. , Kanaji, S. , Yamamoto, M. , Imanishi, T. , Nakamura, T. , Suzuki, S. , Tanaka, K. and Kakeji, Y. (2014) Effects of Subcutaneous Closed Suction Drain for the Prevention of Incisional SSI in Patients with Colorectal Perforation. Surgical Science, 5, 122-127. doi: 10.4236/ss.2014.53022.

Gupta P, Kumar R. Role of subcutaneous drain in reducing surgical site infections after emergency laparotomy. Int Surg J 2017;4:2717-20


Refbacks

  • There are currently no refbacks.