Karthick, R (2020) A Comparative study of Subcutaneous Single Closed Suction Drain Versus Simple Closure in Emergency Midline Laparotomy Wounds. Masters thesis, Government Vellore Medical College, Vellore.
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Abstract
AIM OF THE STUDY: The primary outcome of study is to determine whether the insertion of a subcutaneous closed suction drain at incisional site reduces the incidence of post operative surgical site infection in emergency laparotomy cases. The secondary outcome is to find the effect of closed suction drain in reducing the duration of hospital stay when compared to simple closure. BACKGROUND: Wound healing is major concern after surgical procedure, because of its association with quality of life and morbidity of patients. Infections that occur in the wound created by an invasive surgical procedure are generally referred to as Surgical Site Infections (SSIs). Wound infection continues to be a major problem both in terms of how they affect the outcome of surgical procedure and their impact in the length of hospital stay.Patients requiring Emergency laparotomy procedure has increased risk of surgical site infection and delayed wound healing. Complications following the closure of abdominal layers after correcting the pathology and peritoneal washings are surgical site infections, wound dehiscence, burst abdomen, wound seroma and wound hematoma. There are number of methods have been used to reduce these complications from time to time.Negative suction in the subcutaneous plane decreases infection by removal of serum or debris and by elimination of dead space in the plane.This study is to compare the subcutaneous single closed suction drain and conventional simple closure of skin and subcutaneous tissue in emergency laparotomy cases. MATERIAL AND METHODS: A prospective study done on 100 patients undergoing emergency midline laparotomy surgery in the department of general surgery after ethical committee clearance from Government vellore medical college. On the basis of exclusion and inclusion criteria patients were randomlydivided into two groups. Group A includes 50 patients who had subcutaneous closed suction drain before skin closure. Group B includes 50 patients who had no subcutaneous drain. Antibiotics administered to both groups. Patients were followed daily to check for quantity of drainage and for dressing. Drain was removed when the output is less than 5ml. The outcome of the study was compared in the form of wound complications, interventions, hospital stay and morbidity. RESULTS: Wound complications without subcutaneous drain occurred in 21 patients represents 42% and patients with subcutaneous drain accounts to 14% (7/50). Seroma occurred in 9 patients in the group without subcutaneous drain accounts to 18%. No cases in the drain group has reported seroma (p=0.002). 3 patients (6%) with Hematoma in group B. No patients with drain group had reported hematoma and is statistically insignificant(P=0.079). Average rate of Surgical Site Infection 14 patients without subcutaneous drain(28%) and 6 patients in the drain group (12%). This is statistically significant P value 0.046. Post operative pain reported by 14 patients (28%) without drain and patients with drain had 3 patients (6%) and Significant ( p < 0.05). Length of hospital stay in patients without subcutaneous drain is 9.12±2.51 days and patients with subcutaneous drain is 7.70±1.44 days. Overall morbidity and hospital stay was reduced in patients with subcutaneous closed suction drain. CONCLUSION: In emergency laparotomy procedures, Subcutaneous single closed suction drain reduces postoperative surgical site infection, seroma, postoperative pain and the duration of hospital stay significantly compared to patients in whom negative suction drain was not placed.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221711655 |
| Uncontrolled Keywords: | Subcutaneous Single Closed Suction Drain, Simple Closure, Emergency Midline Laparotomy Wounds. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 12 Feb 2021 17:35 |
| Last Modified: | 12 Feb 2021 17:35 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/14077 |
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