Mohamed Farook, M (2023) An Experimental study on Optimization of Intra Abdominal Pressure in the Perioperative Period and Its Effect on Outcome in Patients Undergoing Laparotomy. Masters thesis, Madras Medical College, Chennai.
Full text not available from this repository.Abstract
INTRODUCTION: Wound complications are still extremely prevalent even in this advanced era of surgery, especially in an emergency situation. There are several factors that contribute to these wound complications, but intra-abdominal hypertension is the one that is least understood. The purpose of this study is to ascertain whether intra abdominal hypertension has a role in wound complications and whether lowering it can help. AIMS AND OBJECTIVES: 1. To determine the incidence of perioperative increased intra abdominal pressure among elective and emergency laparotomy at our institution. 2. Optimization of IAP, if found to be elevated, using WSACS protocols. 3. To correlate whether optimization of perioperative IAP has a positive effect in outcome in the above mentioned cases. MATERIALS AND METHODS: This study was conducted among patients undergoing elective and emergency laparotomy in our institution. 70 patients were enrolled (35 cases and 35 controls). Flowmanometry technique via an indwelling foley’s catheter was used to measure IAP. IAP monitoring was done in the pre-operative period and post operatively at 0, 6, 24 and 48 hours. Among controls, intervention to reduce IAP was carried out according to the WSACS protocols. Incidence of intra-abdominal hypertension in the pre-operative period was computed and Chi-square test was used to correlate between the occurrence of wound complications in cases and controls. RESULTS: The incidence of IAP in the pre-operative period (at admission) ranged from 25% in elective cases and 50% in emergency cases. Mass lesions and hollow viscus perforation were the predominant iintraoperative findings. The overall complication rate was significantly lower in cases (intervention group) than controls (p value = 0.005). When individually analysed, the percentage of wound dehiscence were significantly lower in controls in whom steps to reduce IAH according to WSACS protocol was followed (p value = 0.07). The occurrence of rectus dehiscence were not significant among the two groups. CONCLUSION: This is an experimental case control type of study to analyse the effect of Optimization of intra abdominal hypertension in the post operative period as per the guidelines given by WSACS protocol on the outcome of laparotomy wound in both elective and emergency cases. IAP was measured for all patients who underwent laparotomy (Both elective and emergency) in the study period in our institution and the incidence of intra abdominal hypertension was found to 25% in elective and 50% in emergency cases. The sample size was comprised of 70 patients with eleavted IAP in the immediate post operative period, of which 35 patients were taken as cases and 35 patients were taken as controls. In control group, steps to reduce IAP were carried out according to World Society of the Abdominal Compartment Syndrome(WSACS) protocol, which was not done in the case group. The incidence of wound dehiscence and rectus dehiscence was calculated in both groups and the incidence of wound dehiscence was found to be significantly high in the case group in which measures to reduce IAP was not done, whereas the incidence of rectus dehiscence was found to be insignificant in both groups. Thus from the study we can draw the following conclusions; (1) IAP monitoring by Flowmanometry method is a very easy bedside method which should be followed in all patients undergoing laparotomy. (2) World Society of the Abdominal Compartment Syndrome (WSACS) protocol to manage intra abdominal hypertension is an effective method which should be carried out in all patients with Intra abdominal hypertension in the post operative period. (3) The incidence of wound dehiscence can be reduced to a greater extent with an effective management of intra abdominal hypertension.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | 220120100509 |
| Uncontrolled Keywords: | Optimization, Intra Abdominal Pressure, Perioperative Period, Undergoing Laparotomy. |
| Subjects: | MEDICAL > General Surgery > MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 15 Jan 2024 06:14 |
| Last Modified: | 19 Jan 2024 16:39 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/21299 |
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