Randomized controlled trial of use of drain vs. no drain in open incisional hernia mesh repair

Rahul, Lakshminarayanan (2016) Randomized controlled trial of use of drain vs. no drain in open incisional hernia mesh repair. Masters thesis, Christian Medical College, Vellore.


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INTRODUCTION: Incisional hernias are protrusion of abdominal contents through weakness in the scar of the abdominal wall, following any abdominal operation. They may be primary or recurrent. They commonly occur due to pre-existing risk factors which include age, obesity, chronic obstructive pulmonary disease (especially emphysema), diabetes mellitus, smoking, drug intake around the time of surgery (like steroids), infection at the surgical incision site. These can be repaired surgically by different methods. For incisional hernias with less than 3cm defect primary suturing can be done. For defects of more than 3 cm, mesh hernioplasty is usually done: which can be by sublay / onlay / inlay/ intraperitoneal methods. Onlay method implies placement of a mesh over the anterior rectus sheath and suturing it in place. Sublay method implies placement of mesh behind the rectus muscle (either retro rectus or preperitoneal). Inlay is used for bridging the defect with the mesh. Intraperitoneal is placement of mesh deep to the peritoneal layer, which is usually done as Laparoscopic method. Other method for inadequate anterior wall musculature includes component separation technique. AIMS: The aim of the study is to assess the outcome of drain placement Vs no drain use, in patients undergoing open mesh repair of incisional hernias in the Department of General Surgery, Unit 4. OBJECTIVES: 1. To assess and compare the occurrence of seroma, hematoma and wound infection in the two groups. 2. To assess and compare the duration of hospital stay in both the groups. BACKGROUND: Evidence in literature comparing the outcome following incisional hernia repair with or without drains is scarce. A meta-analysis comparing the same was unable to find suitable randomized controlled trials carried out in this regard. To this effect a randomized controlled trial is proposed to compare the outcome following incisional hernia repair with versus without the use of drains. METHODS: From April 2014 to August 2015, 62 patients pre-operatively planned for sublay or onlay mesh repair were randomised to drain or no drain allocation following informed consent. Their outcomes, specifically seroma/ hematoma, wound infection and duration of hospital stay, were analysed till 30 days post-operatively. Results: There were a total of 17 seromas and 5 infections among all the patients. The incidence of seromas, hematomas and surgical site infections was 24.1%, 3.2% and 8.1% respectively. There was no significant difference in the outcome with regard to drain placement. There was a significant reduction in the duration of hospital stay among the patients in whom no drain was placed (p value <0.05). There was no positive correlation of outcomes to co-morbid illnesses (diabetes mellitus, systemic hypertension, ischemic heart disease, chronic kidney disease, COPD or hypothyroidism). There was no correlation type of repair, BMI, duration of incisional hernia or size of the defect. CONCLUSIONS: There was no significant reduction in the outcome of seromas, hematomas or surgical site infections with regard to drain placement. There was a significant reduction of duration of hospital stay in patients for whom drain is not placed.

Item Type: Thesis (Masters)
Uncontrolled Keywords: incisional hernia ; mesh repair ; drain ; seroma ; hematoma ; infection ; hospital stay.
Subjects: MEDICAL > General Surgery
Depositing User: Subramani R
Date Deposited: 12 Oct 2017 01:03
Last Modified: 12 Oct 2017 01:03
URI: http://repository-tnmgrmu.ac.in/id/eprint/3557

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