Vairavan, J L (2020) A Comparative study of Use of Gentamycin Impregnated Mesh Over Conventional IV Gentamycin in Hernial Surgery for the Prevention of SSI. Masters thesis, Coimbatore Medical College, Coimbatore.
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Abstract
INRODUCTION: Surgical site infection (SSI) accounts for 20% of all healthcare-associated infections. Approximately 5% of patients undergoing surgery develop SSI.SSI results in failure of wound healing with subsequent increased treatment costs, a greater likelihood of admission to the intensive care unit, prolonged hospital stay and higher post-operative mortality. In particular, studies have demonstrated an extra 7–10 days inpatient stay in those with SSI .There are many interventions advocated to reduce SSI, including pre-operative assessment to optimize underlying disease such as diabetes mellitus, aseptic techniques in the operating theatre and the use of systemic prophylactic antibiotics. AIM OF THE STUDY: The aim of this study is to classify the patients based on their co morbid conditions and preferably select a group of non diabetic preoperative patients undergoing hernial surgeries For which cases are given gentamycin impregnated polypropylene mesh with no iv antibiotics post operatively Controls are given IV gentamycin They are followed up to post operative period and efficacy is compared OBJECTIVES: 1 To apply the practice of gentamycin instilled mesh in preventing surgical site infections. 2 To assess the practicality and usefullness of this technique. 3 To assess the outcome and predictability and efficiency of feasibility of the idea . 4 To validate this tool. JUSTIFICATIONS FOR THE STUDY: The working methodology of this technique is easy to carry out necessary assessment are carried out pre operatively itself eliminating the nessicity for new investigations. Patient friendly and pain free approach. STUDY DESIGN: This is a Prospective Cohart study. STUDY POPULATION: Patients are selected on the basis of in patient administration planned for elective hernial surgeries that include inguinal, umbilical and incisional ,in any age groups . Free from co morbidities especially diabetes and kidney failure and followed up post operatively without supplementation of single dose of intravenous antibiotics The only antibiotic they are likely to be exposed is gentamycin that is instilled over the mesh intra operatively Control Population: Patients are selected on the same basis as that of the study group except for the fact that they receive intravenous gentamycin in the immediate post operative period that is carried out for atleast 5 days. Duration of study: For a period of one year from January 2018 - January 2019. Sample size: N=100. Inclusion criteria: Patients posted for non emergent elective hernial surgeries (inguinal) without the exposure to any form of antibiotics that includes oral,topical and intravenous route with limited stay in hospital for atleast 5 days of post operative period Exclusion criteria: Patients undergoing emergency procedures. Patients with significant co morbid conditions especially uncontrolled diabetes and renal failure . Patients exhibiting known kind of allergic reactions or propensity to develop contact dermatitis when subjected to exposure gentamycin. Patients undergoing major abdominal surgeries like resection anastamoses, colo rectal surgeries etc. Potential benefits: Low cost, More efficient and easier to carry out, Avoid unwanted exposure to high concentration of antibiotics systemically, Prevents development of antibiotic resistance, Prevents the side effects of antibiotics especially nephrotoxicity, Excellent affordability METHODOLOGY: Patients are selected undergoing surgeries for inguinal hernias. Patients are evaluated and pre operative work up is done. Patients are selected based on inclusion and exclusion criteria. To one set of patients ,intra operatively polypropylene mesh is impregnated with gentamycin antibiotic. To other set of patients gentamycin is given in the immediate post operative period for the period of 3 days as one time dose. Patients are compared with each other through regular follow up after surgical procedure and examined for surgical site infections and are compared with each other based on their outcome. CONCLUSION: Though there were not multiple studies that were undertaken to contribute to my study, this is a small initiative that was undertaken to implement this new idea of use of impregnanted meshes for hernia surgeries.so once done in the operating room itself patient doesn’t require a continuous monitoring of look of the wound till the first look. post operatively pain killers ,analgesics and vitamin supplements are sufficient enough to give it to the patients. Surgical site infection that presents in higher age groups, also have many co morbid factors along with them. but since hernia is reported at higher incidence in age groups more than 30 one can attribute the cause of infection to wide range of factors extending from common nutritional causes extending to rare genetic causes. The use of gentamycin was not just a random choice for impregnation as its efficacy was tested in some condition. further more challenging uses of the use of impregnated meshes are yet to be tested in forthcoming years.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221711316 |
| Uncontrolled Keywords: | Gentamycin, Impregnated Mesh Over Conventional IV Gentamycin, Hernial Surgery, Prevention, SSI. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 10 Feb 2021 18:26 |
| Last Modified: | 10 Feb 2021 18:26 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/14027 |
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