A prospective, non-randomized study to determine the role of intraperitoneal drain placement in perforation peritonitis

BACKGROUND: Surgical site infection continues to be a major problem after laparotomy for perforation peritonitis, as it increases morbidity and hospital stay and decreases the quality of life. Intra-abdominal drain placement is a routine practice in perforation peri-tonitis. The aim of our study is to compare the incidence of surgical site infection in two groups of patients who were operated for perforation peritonitis: The first group received the intraperitoneal drain, while no drain was placed in the second group.
METHODS: The present single-center, prospective, non-randomized study was conducted in the Department of General Surgery at the Postgraduate Institute of Medical Education and Research, India. A total of 122 patients underwent exploratory laparotomy for gastroduodenal and small bowel perforation peritonitis, of which 100 participants were included in this study, based on specified cri-teria for inclusion and exclusion. A total of 50 participants each were included in the drain group and the no drain group, respectively. A drain was placed in every alternate patient with perforation peritonitis who received primary closure or resection anastomosis. Patients with diabetes, renal failure, and hemodynamic instability and those who presented more than 72 h since symptom onset were excluded from the study. Peritoneal fluids were cultured. The primary endpoint was to identify the incidence of surgical site infections (SSIs) in the two groups. We also compared the time taken for the return of bowel movements, duration for which a nasogastric tube was inserted, whether any intervention was performed under local or general anesthesia within 30 days of surgery, the duration of hospital stay, and the ease of diagnosing repair leak in the post-operative period in both the groups.
RESULTS: Demographics of participants in both the groups were matched. No significant difference was observed between the drain and no-drain groups with respect to the incidence of surgical site infection (p=0.779). The duration of surgery and length of hospital stay were significantly lower in the no drain group. A significant difference was observed between the two groups concerning the peritoneal culture growth, and increased bacterial growth was seen in the drain group. No significant difference in morbidity was noted between the two groups, which was classified according to the Clavien-Dindo classification.
CONCLUSION: Routine use of intra-abdominal drains was not found to be effective in preventing SSIs, but a selection bias cannot be ruled out. Patients with no drains had a significantly shorter duration of hospital stay.

Perforasyona baðlý peritonitte intraperitoneal dren takýlmasýnýn rolünü belirlemeye yönelik prospektif, randomize olmayan bir çalýþma

AMAÇ: Perforasyona baðlý peritonitte laparotomi sonrasý cerrahi alan enfeksiyonu, morbiditeyi ve hastanede kalýþ süresini arttýrdýðý ve yaþam kalitesini düþürdüðü için önemli bir sorun olmaya devam etmektedir. Perforasyona baðlý peritonitte karýn içi dren yerleþtirilmesi rutin bir uygulamadýr. Çalýþmamýzýn amacý perforasyona baðlý peritonit nedeniyle ameliyat edilen iki grup hastada cerrahi alan enfeksiyonu insidansýný karþýlaþtýrmaktýr: Birinci grupta karýn içi dren yerleþtirilmiþken, ikinci gruba dren yerleþtirilmedi.
GEREÇ VE YÖNTEM: Mevcut tek merkezli, ileriye yönelik, randomize olmayan çalýþma, Hindistan’da Yüksek Lisans Týp Eðitimi ve Araþtýrma Ens-titüsü Genel Cerrahi Anabilim Dalý’nda yürütülmüþtür. Gastroduodenal ve ince baðýrsak perforasyonuna baðlý peritonit için keþif amaçlý laparotomi uygulanan toplam 122 hastadan 100’ü, belirtilen dahil edilme ve hariç tutulma kriterlerine göre bu çalýþmaya alýndý. Dren grubuna ve drensiz gruba her birinde 50 katýlýmcý olacak þekilde hasta alýndý. Primer kapama veya rezeksiyon-anastomoz yapýlan perforasyon peritonitli her alternatif hastaya bir dren yerleþtirildi. Diyabet, böbrek yetmezliði ve hemodinamik instabilitesi olan hastalar ve semptom baþlangýcýndan bu yana 72 saatten fazla zaman geçtikten sonra baþvuranlar çalýþma dýþý býrakýldý. Periton sývýlarýndan kültür alýndý. Birincil son nokta, iki grupta cerrahi alan enfeksiyonlarýnýn insidansýný belirlemekti. Ayrýca her iki grupta da baðýrsak hareketlerinin geri dönüþü için geçen süreyi, nazogastrik sondanýn (NGS) takýlma süresini, ameliyattan sonraki 30 gün içinde lokal veya genel anestezi altýnda herhangi bir müdahale yapýlýp yapýlmadýðýný, hastanede kalýþ süresini ve postope-ratif dönemde onarým kaçaðý tanýsýnýn konulma kolaylýðýný karþýlaþtýrdýk.
BULGULAR: Her iki gruptaki katýlýmcýlarýn demografik özellikleri eþleþtirildi. Cerrahi alan enfeksiyonu insidansý açýsýndan drenli ve drensiz gruplar arasýnda anlamlý bir fark gözlenmedi (p=0.779). Dren olmayan grupta ameliyat süresi ve hastanede kalýþ süresi anlamlý olarak daha kýsaydý. Peritoneal kültürde üreme açýsýndan iki grup arasýnda anlamlý fark gözlendi ve dren grubunda bakteri üremesinde artýþ görüldü. Clavien-Dindo sýnýflamasýna göre sýnýflandýrýlan iki grup arasýnda morbidite açýsýndan anlamlý bir fark görülmedi.
TARTIÞMA: Karýn içi drenlerin rutin kullanýmý cerrahi alan enfeksiyonlarýný önlemede etkili bulunmadý, ancak seçim yanlýlýðý göz ardý edilemez. Dren olmayan hastalarýn hastanede kalýþ süreleri önemli oranda daha kýsaydý.