Subcutaneous negative pressure versus simple closure of skin incision following an emergency laparotomy: a randomized control study

Authors

  • Rakesh Kagita Department of General Surgery, Sri Dharmasthala Manjunatheswara College of Medical Sciences and Hospital, SDM University, Dharwad, Karnataka, India
  • Sameer Ahmed Mulla Department of General Surgery, Sri Dharmasthala Manjunatheswara College of Medical Sciences and Hospital, SDM University, Dharwad, Karnataka, India
  • B. Srinivas Pai Department of General Surgery, Sri Dharmasthala Manjunatheswara College of Medical Sciences and Hospital, SDM University, Dharwad, Karnataka, India
  • Mallikarjun Desai Department of General Surgery, Sri Dharmasthala Manjunatheswara College of Medical Sciences and Hospital, SDM University, Dharwad, Karnataka, India

DOI:

https://doi.org/10.18203/2349-2902.isj20191254

Keywords:

Abdominal surgery, Subcutaneous negative pressure drain, Surgical site infection

Abstract

Background: Surgical site infection (SSI) is a major problem associated with open abdominal surgery and is related to increased morbidity, mortality and healthcare costs. A subcutaneous negative pressure drain reduces dead space in subcutaneous tissue by preventing accumulation of fluid. The aim of present study was to establish the efficacy of a subcutaneous negative pressure for preventing SSI following exploratory laparotomy.

Methods: A total of eligible 76 patients who underwent emergency abdominal surgical procedure, between October 2016 to March 2018, were randomized into subcutaneous drainage (DG) and no drainage group (NDG). Antibiotic prophylaxis was applied to each patient. The diagnosis of superficial SSI was made and was graded according to Southampton Grading System.

Results: 5 patients in drain group (40) and 25 patients in no drain group (36) had incisional SSI with statistical difference (p<0.05). No statistical difference between groups was observed for age, sex, hospital stay (p>0.05).

Conclusions: Subcutaneous negative pressure prevents post-operative surgical site infection significantly. Subcutaneous negative pressure drainage reduces hospital stay in a patient undergone emergency laparotomy, compared to patients in whom negative pressure drain was not placed.

Metrics

Metrics Loading ...

Author Biography

Rakesh Kagita, Department of General Surgery, Sri Dharmasthala Manjunatheswara College of Medical Sciences and Hospital, SDM University, Dharwad, Karnataka, India

GENERAL SURGERY

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, 27th 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. 2018: 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.

Downloads

Published

2019-03-26

Issue

Section

Original Research Articles