Role of abdominal drains in perforated peptic ulcer patients- A prospective randomized controlled study

Abstract

Background: Perforated peptic ulcer is a common emergency condition worldwide, with associated mortality rates of up to 30%. Although Helicobacter pylori and use of non-steroidal anti-inflammatory drugs are common causes, demographic differences in age, sex, perforation location, and underlying causes exist between countries, and mortality rates also vary. The routine to date has been to leave two tube drains: one in the Morrison's pouch and one in the pelvis after omental patch closure. This study was conducted to test the efficacy and safety of drain usage routinely after peptic ulcer perforation closure with omental patch technique. Materials & Patients: This is observational study was carried out at our rural Medical College in Bihar from the period October 2015 to June 2017. The aim was to know use of abdominal drain in peptic perforation (D1). As matter of study 50 cases was studied it was seen that there is more chance of infection after abdominal drain and less infection noticed in the case without drain. Mortality rate is more in laparotomy with drain. Clinical parameters: a) post operative fever, b) abdominal distension, rigidity, pain; c) post operative diarrhoea and d) vomiting were noted. Per rectal examination to detect boggy swelling or collection in the pelvis was done. Routine haematological and biochemical investigations were also evaluated. Wound infection, burst abdomen, time of return of bowel function, drain site infection and details of drainage were noted. Results: The mean age (mean± S.D.) of the all patients was 42.20±8.52 years with range 25-67 years and the median age was 41 years. In group A, the mean age (mean± S.D.) of patients was 44.36±9.54 years with range 32-67 years and the median age was 42 years. In group B, the mean age (mean± S.D.) of patients was 40.04±6.89 years with range 25-55 years and the median age was 40 years. In group A, per rectal examination to see pelvic collection postoperatively was observed in with drain patients 6 (24%) and without drain patients 8 (32%) but this association was not statistically significant (p = 0.53). Burst abdomen was significantly higher in with drain patients number is 4 patients (16.0%) than without drain patients 0 (0.0%) and this association was statistically significant (ᵪ2= 4.34, p=0.03). Conclusion: So our conclusion is that, if the proper toileting of the abdominal cavity can be achieved with care there is no role of putting abdominal drains as prophylactic drainage, in cases of perforated peptic ulcer diseases mainly D1 perforation.

The Use of Abdominal Drains in Perforated Peptic Ulcer

“…Complications occur at a rate of 1-2% per ulcer per year, with a lifetime risk of perforation around 10% for untreated duodenal ulcers [4]. Despite advancements in medical treatment, peptic ulcer perforation necessitates urgent surgical intervention, carrying short-term mortality of approximately 30% and morbidity of 50% [5][6][7].…”