Closure of Emergency Midline Laparotomy over Subcutaneous Closed Suction Drain to Mitigate Incisional Surgical Site Infection, Dehiscence and Hernia: A Prospective Comparative Study

Abstract

Background: The role of subcutaneous closed suction drainage (SCSD) during closure of emergency midline laparotomy (EML) for reduction of incisional surgical site infection (ISSI) remains debatable. Objective: The aim of the work was to investigate whether SCSD could minimize ISSI in the setting of emergency abdominal surgery. Patients and Methods: Adult patients with non-traumatic acute abdomen who underwent EML from June 2017 to January 2021 by single surgical team at Sohag University Hospital were prospectively enrolled. Patients were randomized according to EML incision closure technique into group A without SCSD and group B with closure of EML over SCSD. Both groups were compared regarding ISSI, wound dehiscence and incisional hernia. Results: Fifty-four patients were eligible (27 per group) with median age of 62 (range: 19-81) years. Both groups were comparable regarding gender and age. Group B exhibited significantly lower rates of ISSI (3 patients, 11%) and wound dehiscence (zero) compared with group A, (12 patients, 44%) and (5 patients, 15%), respectively. Likewise, the duration of hospital stay was significantly shorter among patients in group B versus those in group A. Relaparotomy was required in 2 cases due to disruption of small bowel anastomosis in group A and leaking repair of duodenal ulcer in group B. After a median follow-up of 26 (range: 7 -44) months, the protective effect of SCSD against ISSI correlated with significantly lower incidence of incisional hernia in group B (1 patient, 3.7%) in comparison with group A (5 patients, 18.5%). Conclusion: It could be concluded that mitigation of ISSI, wound dehiscence and incisional hernia with subcutaneous closed suction drainage favors its routine application during closure of non-traumatic EML.

Role of closed subcutaneous drain in prevention of surgical site infection in perforation peritonitis

“…8 El-Badry et al in his study on emergency laparotomy cases found the SSI rate to be 11% in patients with subcutaneous drain and 44% in patients without subcutaneous drain. 9 Present study revealed the incidence of SSI in patients with subcutaneous drain (group A) as 33% and without subcutaneous drain as 70%. Decreased incidence of SSI in patients with subcutaneous suction drain can be attributed to the fact that usage of subcutaneous suction drain is effective in reducing SSI incidence.…”

“…El-Badry et al in his study posted the rate of wound dehiscence in patients with SSI as 15% in patients without subcutaneous drain and no wound dehiscence was seen in patients with subcutaneous drain placement. 9 Bindal et al in his study posted that the rate of wound separation in patients with SSI with subcutaneous drain was 4% and 8% without subcutaneous drain placement. 10 In our study the rate of wound dehiscence in patients with SSI was found to be 40% in patients with subcutaneous drain and 76% in patients without subcutaneous drain.…”