Outcomes of Subcutaneous Negative Pressure Drain Closure in Laparotomy Wound of Gastrointestinal Perforation

Résumé

Background: Gastrointestinal perforation usually occurs when a hole forms all the way through the stomach, large bowel or small intestine. Surgical site infection is very common in patients of perforation peritonitis if the wound is primarily closed in the setting of gross abdominal contamination. In managing such cases,surgeons usesubcutaneous negative pressure drain closure to achieve better success than simple closure method. Aim of the study: The aim of this study was to evaluate the outcomes of subcutaneous negative pressure drain closure in laparotomy wound of gastrointestinal perforation. Methods: This clinical trial was conducted at the Surgical Units of Dhaka Medical College Hospital, Dhaka, Bangladesh during the period from July 2014 to June 2015. In total 56 patients who underwent emergency operations for gastrointestinal perforation admitted in department of surgery of the mentioned hospital were included in the study as study subjects.In the treatment procedure, negative suction drain was used at the time of closure of the abdomen after perforation and thorough peritoneal toilet. The outcomes were evaluated regarding the form of wound infection, hospital stay, second surgery and morbidity. Death cases were excluded from the study. Results:Among total 56 participants, the incidence of post-operative s-SSI was found among 30% (n=17) cases.The highest frequency of s-SSI was found in patients with BMI: 18.5–25 Kg/m2 which was 16.03%. Besides this, 5.36% and 8.99% incidences were found among patients where the BMIs were found as <18.5 and > 25 Kg/m2 respectively.As the site of perforation, duodenum was associated among 7 cases which contributed the highest number of incidences as a single site. The mean ±SD hospital staying period of the participants was 12 ±1.76 days.As the management, conservative treatment was performed in 64.71% cases. Besides this, secondary suturing and ‘tension suture for burst abdomen’ were done among 29.41% and 5.88% cases respectively. Conclusion: As per the findings of this study, we can conclude that, in complicated cases and to ensure better patient compliance, subcutaneous negative pressure drain closure may be considered as an effective method in managing laparotomy wound of gastrointestinal perforation.