scholarly journals Role of subcutaneous drain in class III and class IV laparotomy wound

2019 ◽  
Vol 6 (5) ◽  
pp. 1495
Author(s):  
Pranav R. Patel ◽  
Himanshu B. Koyani
Keyword(s):  
Comparative Study ◽  
General Surgery ◽  
Surgical Site Infections ◽  
Cost Effective ◽  
P Value ◽  
Emergency Laparotomy ◽  
Class Iii ◽  
Laparotomy Wound ◽  
Class Iv

Background: Surgical site infections (SSI) are major problem in general surgery. Aim of this study is to know the role of subcutaneous conrrugated drain in class III and IV laparotomy wounds.Methods: Comparative study was done in 100 patients of emergency laparotomy in civil hospital, Gandhinagar from January 2014 to December 2016.Results: Incidence of surgical site infections were significantly lower (16%) in patients with subcutaneous drain, compared to 40% in patients without drain (p value 0.01).Conclusions: Corrugated subcutaneous drain is cost effective way of reducing surgical site infections and subsequent morbidities in class III and IV laparotomy wound.

scholarly journals A prospective comparative study of efficacy of pulse jet irrigation and conventional irrigation techniques in prevention of surgical site infections in laparotomy wounds

2019 ◽  
Vol 6 (2) ◽  
pp. 557
Author(s):  
Sharath Kumar V. ◽  
Naveen N. ◽  
Purushotham T. S.
Keyword(s):  
Comparative Study ◽  
Wound Care ◽  
Invasive Procedure ◽  
Surgical Site Infections ◽  
P Value ◽  
Emergency Laparotomy ◽  
Wound Irrigation ◽  
Superficial Infection ◽  
Study Results ◽  
Prospective Comparative Study

Background: Surgical Site Infections (SSIs) are infections of tissues, organs or spaces exposed by surgeons during performance of an invasive procedure and continue to be a major source of morbidity following operative procedures. Wound irrigation is the steady flow of a solution across an open wound surface meant to remove cellular debris and surface pathogens contained in wound exudates or residue from topically applied wound care products.Methods: This prospective comparative study was conducted to compare the effectiveness of Pressurized Pulse Irrigation (PPI) and Standard Irrigation Technique (SIT) in laparotomy wounds. Duration of the study was for a period of 12 months and included 100 consecutive patients undergoing laparotomy.Results: 13% of patients who underwent laparotomy had SSI out of which 9 patients had superficial infection only. 8% of 50 patients who had PPI developed SSI, whereas 18% of those who underwent SIT had SSI. Though PPI had less incidence of SSI, statistically it was insignificant.Conclusions: The study showed a decrease in the incidence of postoperative SSI in both elective and emergency laparotomy wounds irrigated with PPI compared to SIT, though the study was statistically insignificant since the p value was less than 0.005 with a odds ratio of 2.52. The study results suggested that there was decrease in the incidence of SSI in PPI patients and also that it decreases the postoperative stay, morbidity and cost.

A COMPARATIVE STUDY OF EFFICACY, POTENCY AND RECOVERY OF INTRATHECAL 0.5% ROPIVACAINE WITH FENTANYLAND 0.5% LEVOBUPIVACAINE WITH FENTANYL IN LOWER ABDOMINAL SURGERIES IN PATIENTS OF 18-60YEARS OF AGE

2021 ◽  
pp. 74-76
Author(s):  
Payel Mitra ◽  
Archana Roy ◽  
Aamir Huda
Keyword(s):  
Comparative Study ◽  
Motor Block ◽  
Length Of Hospital Stay ◽  
Cost Effective ◽  
Outpatient Setting ◽  
P Value ◽  
Equal Concentration ◽  
Medical College ◽  
Institutional Ethics ◽  
Care Surgery

INTRODUCTION:The recent trend in health care centres everywhere is to provide cost effective care to the patients. There is an increasing trend towards ambulatory day care surgery and rapid discharge of the patients. The operation of inguinal hernia or incisional hernia and even simple ligation surgeries are done without much complexities nowadays and can be completed in 60-90min without much intra or postoperative complications. Hence these have become an ideal procedure for outpatient setting and thereby reducing length of hospital stay. AIMS AND OBJECTIVE:A comparative study of efcacy, potency and recovery of intrathecal 0.5% ropivacaine with fentanyl and 0.5% levobupivacaine with fentanyl in lower abdominal surgeries in patients of 18-60years of age. MATERIALS AND METHOD: This is a prospective, comparative, observational study was conducted on 60 patients undergoing various lower abdominal surgeries under subarachnoid block (SAB) at Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal. This study was conducted over a period of 24-month. Approval of the Institutional Ethics Committee was taken. Awritten informed consent in the local language was taken from every patient. RESULT AND ANALYSIS: In RF 5 patients (17%) had onset at 3min, 17patients (57%) at 6min, 7 patients (23%) at 9min, 1 patient (3%) at 12min. In LBF 8 patients had onset at 0 min, 22 patients had onset at 3min. p value is less than 0.0001 which is statistically signicant. In RF, 23 patients (77%) had duration of motor block for 150min and 7 patients (23%) had for 180min. In LBF, 26 patients (87%) had duration of motor block for 210 min and 4 patients (13%) had for 180min. The p value is less than 0.0001, which is statistically signicant. SUMMARYAND CONCLUSION: This study was to compare potency, efcacy and recovery between the two groups of drugs. A potency of a drug is a measure of drug activity expressed in terms of the amount required to produce an effect of given intensity. Here both the drugs in comparison was given in equal concentration and found that levobupivacaine produced higher effect, reached Bromage 3 in lesser time than ropivacaine. So levobupivacaine was more potent drug. Efcacy is the ability to get a job done satisfactorily

scholarly journals Single vs Multiple Antibiotic Drug Regimen in Preventing Infectious Morbidity in Caesarean Section: A Randomised Clinical Trial

2021 ◽  
Author(s):  
Subhashchandra R Mudanur ◽  
Shreedevi S Kori ◽  
Aruna Biradar ◽  
Rajasri G Yaliwal ◽  
Dayanand S Biradar ◽  
...  
Keyword(s):  
Single Dose ◽  
Caesarean Section ◽  
Multiple Dose ◽  
Caesarean Delivery ◽  
Surgical Site Infections ◽  
Cost Effective ◽  
P Value ◽  
Infectious Morbidity ◽  
Group A ◽  
Group B

Introduction: Surgical site infections are a serious cause of maternal morbidity and mortality. Various preventive measures are being used to reduce the incidence of surgical site infections. One of them is the use of prophylactic antibiotics. In this study, authors have evaluated three antibiotic regimen with respect to preventing infectious morbidity in caesarean section. Aim: To study the efficacy and cost-effectiveness of a single dose (ceftriaxone) versus multiple doses of antibiotic therapy (ceftriaxone and ornidazole) administered preoperatively in women undergoing caesarean delivery. Materials and Methods: A prospective interventional study was conducted on 300 pregnant women undergoing emergency or elective caesarean delivery. Study was conducted at BLDE (DU) Shri BM Patil Medical College and Research Centre, Vijayapur, Karnataka, India. Patients were randomly assigned to three groups by block random sampling with 100 women in each group. Group A received Inj. ceftriaxone 1 gm single dose 60 minutes prior to commencement of surgery. Group B received Inj. ceftriaxone 1 gm along with Inj. ornidazole 500 mg intravenous infusion 60 minutes prior to commencement of surgery and Group C received Inj. ceftriaxone 1 gm and Inj. ornidazole 500 mg intravenous infusion 60 minutes prior to commencement of surgery and a repeat dose 12th hourly for 24 hours followed by Tab. cefixime 200 mg and Tab. ornidazole 500 mg twice daily for four days postoperatively. The effectiveness of therapy was measured in terms of adverse effects of antibiotics such as nausea and vomiting and postoperative complications like pyrexia, foul smelling lochia, surgical site infections, uterine tenderness, peritonitis and endometritis. Results: There was no statistical difference in outcome measures in side-effects of antibiotics (p-value=0.13), fever (p-value=0.68), lochia discharge (p-value=0.88), wound infection (p-value=0.39) and peritonitis (p-value=0.30) among the three groups. The single dose medication in group A had a cost of Rs.60 INR (0.82 cents USD), which was significantly less compared to the multiple dose regimens in group B that cost Rs.203 INR ($2.76 USD). The mean hospital stay in non infectious and infectious patients were 5 and 10 days in present study (p<0.0001). Conclusion: Caesarean delivery poses 5-20 times greater risk of postoperative infection when compared to vaginal birth. There has been a shifting trend of increasing caesarean deliveries and postoperative infections can contribute to overwhelming health and economic burden. Present study shows outcome measures which were statistically insignificant among the three study groups with different prophylactic regimen for caesarean delivery, so it’s safe to state that both single dose and multiple dose regimen provided equal protective coverage in reducing maternal infectious morbidity. Also, single dose regimen proved to be cost-effective. So, to conclude single dose prophylactic antibiotic given preoperatively in caesarean section is both cost-effective and as is efficient.

scholarly journals Role of subcutaneous suction drain in reducing surgical site infections after emergency laparotomy

2017 ◽  
Vol 4 (8) ◽  
pp. 2717
Author(s):  
Poonam Gupta ◽  
Rajesh Kumar
Keyword(s):  
Surgical Site Infection ◽  
Significant Role ◽  
Surgical Site Infections ◽  
P Value ◽  
Emergency Laparotomy ◽  
Emergency Setting ◽  
Site Infection ◽  
Randomised Study ◽  
Suction Drain ◽  
Drain Group

Background: One of important morbidity postoperatively is surgical site infection and the important cause is collection of blood and serous fluids which can get infected and this factor is even more important in emergency laparotomies. our prospective randomised study compares the incidence of surgical site infection in post emergency abdominal surgical wounds with subcutaneous suction drains versus those in whom drain was not placed.Methods: A prospective interventional study of 100 subjects done in department of surgery at rural tertiary centre. on the basis of exclusion and inclusion criteria patient were randomly selected for cases (with post-operative suction drain) and controls. subcutaneous drain in emergency setting play significant role in reducing the incidence of surgical site infection which is significant statistically.Results: 24% of patients in drain group develop surgical site infections. 50% of patients in non-drain group develop infection. Incidence of infection in drain group was lower than the no drain group (p value 0.05) and was statistically significant.Conclusions: Subcutaneous drain in emergency laparotomy play significant role in reducing the incidence of surgical site infection

scholarly journals A Comparative Study between Conventional Sutures, Staples and Adhesive Glue for Clean Elective Surgical Skin Closure

2021 ◽  
pp. 90-97
Author(s):  
Kiran Mastud ◽  
Y. R. Lamture ◽  
Meenakshi Yeola(Pate)
Keyword(s):  
Wound Healing ◽  
Comparative Study ◽  
General Surgery ◽  
Healing Process ◽  
Surgical Site Infections ◽  
Skin Closure ◽  
Medical Sciences ◽  
Surgical Stapler ◽  
Post Operative Pain ◽  
Spss Software

Background: A surgeon's signature is 'scar' [1]. On a regular basis, surgeons face various kinds of wounds which must be healed. The healing process and cosmetic result can be influenced by wound and incision closure techniques. The Goal of this Research is to Compare 3 Skin Closure Techniques: conventional skin sutures, adhesive glue, surgical stapler. These methods will be used to determine which of them is superior in terms of wound healing and cosmetic outcome in clean elective surgeries. Objectives: To compare duration between closure by 3 methods. To compare prices amongst the 3 methods. A comparison of the cosmetic appearances of the skin after closure. A comparison of post-operative pain between the 3 methods. To assess surgical site infections after closure with these 3 methods Methodology: 90 patients, undergoing clean elective surgeries, will be included in this study. 30 patients will be included in every group. Hospitalised under Department of General Surgery in Datta Meghe Institute Of Medical Sciences, Wardha. The study will be conducted between October 2020 to October 2022. Results: The result would be undertaken in SPSS software. Conclusion: Conclusion will be based on findings of study protocol.

TP6.2.1 Does the use of Negative Pressure Wound Dressings decrease superficial Surgical Site Infections in the Emergency Laparotomy?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Eleanor Smith ◽  
Hannah Merriman ◽  
Safia Haidar ◽  
Grace Knudsen ◽  
Victoria Kinkaid ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Intervention Group ◽  
Surgical Site Infections ◽  
Wound Dehiscence ◽  
Wound Dressings ◽  
Emergency Laparotomy ◽  
Post Intervention ◽  
Significant Difference ◽  
The Cost

Abstract Aims Surgical site infection (SSI) can be a significant cause of morbidity in the emergency laparotomy patient. Previous research into the role of negative pressure wound dressings to improve the rate of SSI culminated with NICE guidelines in 2019 recommending the use of negative pressure wound dressings in people who would be considered high risk for developing an SSI. Based on this guideline, we changed our policy to recommend the use of PICO dressings for all emergency laparotomies in order to decrease our rate of SSI. Our aim of this study was to assess the success of this policy change. Methods In this closed-loop audit we analysed data from all laparotomy patients at Frimley Park Hospital over 12 months. We retrospectively analysed the data of the pre-intervention group between January – June 2019, and prospectively audited all laparotomy patients between July – December 2019. Results We found that there was no significant decrease in the rate of superficial SSI, from a pre intervention rate of 22.2% to a post intervention 24.1%. Similarly, we found no significant decrease in the rate of wound dehiscence, which increased from 13.8% to 17.7%. In further assessment we saw no significant difference in the rates of contamination, ASA grades, or closure techniques to account for these increased rates. Conclusion While other studies have demonstrated a decrease in SSIs following the use of PICO dressings, we did not show such a result, leading us to question the cost-effectiveness of negative pressure wound dressings in the emergency laparotomy patient.

scholarly journals EP.FRI.16 Use of Pulsed Lavage Reduces the Rate of Surgical Site Infection After Laparotomy

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Michael Bath ◽  
Jordan Powell ◽  
Ismail Ismail ◽  
Michael Machesney
Keyword(s):  
Risk Factors ◽  
General Surgery ◽  
Effective Means ◽  
Multivariate Logistic Regression Analysis ◽  
Surgical Site Infections ◽  
Cost Effective ◽  
Control Group ◽  
Potential Cost ◽  
Operative Complication ◽  
Pulsed Lavage

Abstract Aims Surgical site infections (SSIs) are a preventable and common post-operative complication within general surgery. Intra-operative irrigation of surgical incisions is an inexpensive method to reduce post-operative SSI rates, however its use is currently limited to orthopaedic surgery. We aimed to assess the effects of pulsed lavage (PL) irrigation on SSI rates following elective and emergency laparotomies. Methods Elective and emergency patients who underwent a laparotomy between 2018 and 2019 were included. Relevant demographic and peri-operative risk factors collected retrospectively, following STROBE criteria. The primary outcome was rate of superficial SSIs within 30 days of the operation. Independent risk factors were assessed via multivariate logistic regression analysis. Results 176 patients were identified, with an average age of 60.7 ±19.1 years. 82.4% (145/176) were emergencies and the mean ASA grade was 2.8. Fifty two patients (29.5%) had PL used during their operation. Thirty seven patients (29.8%, 37/124) in the control group developed a SSI, compared to seven patients (13.5%, 7/52) in the PL group (p = 0.022). At multi-variate analysis, the use PL conferring an Odds Ratio 0.36 (CI 0.12-0.94, p = 0.047) for developing a SSI. Conclusions PL appears to significantly reduced the rate of SSI following laparotomy. There remains scope to reduce the incidence of this common and expensive post-operative complication, and PL could provide a potential cost-effective means to deliver improved outcomes. Future prospective randomised trials are essential to fully assess its benefits and wider use within general surgery.

scholarly journals Mass closure versus layered closure of midline laparotomy incisions: a prospective comparative study

2018 ◽  
Vol 5 (2) ◽  
pp. 584 ◽  
Author(s):  
Santoshkumar N. Deshmukh ◽  
Audumbar N. Maske
Keyword(s):  
Comparative Study ◽  
Wound Closure ◽  
Tertiary Care ◽  
Cost Effective ◽  
Closure Technique ◽  
Midline Laparotomy ◽  
Mass Closure ◽  
Prospective Comparative Study ◽  
Laparotomy Wound ◽  
Closure Group

Background: The ideal method of abdominal wound closure remains to be discovered. It should be technically so simple that the results are as good in the hands of a trainee as in those of the master surgeon. The best abdominal closure technique should be fast, easy, and cost effective while preventing both early and late complications. Present study is undertaken to compare the two methods (Mass closure and Layered closure) of laparotomy wound closure in relation to post-operative complications, time for wound closure and cost effectiveness in both groups and also to decide the most effective method among the two.Methods: This prospective comparative study was conducted in department of surgery at a tertiary care teaching hospital at Solapur (Maharashtra) from January 2006 to January 2009. On admission, patients suspected of having intraabdominal pathology, a thorough clinical e and general assessment was done. Necessary radiological and biochemical investigations were done to support the diagnosis. After confirmation of diagnosis patients were subjected for exploratory laparotomy. The laparotomy wound was closed with either by Mass closure or Layered closure technique. Patients were followed up for 6 months in post-operative period for detection late complications.Results: Total 60 patients of were studied. Majority of patients were in 61 to 65 age group. Male outnumbered the females. Incidence of early complications like seroma, wound infection is more in layered closure group as compared to mass closure. Mean wound closure time is more in layered closure group. Mass closure technique is more cost effective than layered closure group.Conclusions: Mass closure technique is less time consuming, more cost effective and safe for closure of midline laparotomy incisions.

scholarly journals Evaluation of the role of pre-operative albumin and its post-operative drop in the prediction of outcomes of emergency laparotomy

2020 ◽  
Vol 7 (4) ◽  
pp. 1234
Author(s):  
Devaprashanth Mohan Kumar ◽  
Sindhu Sivakumar
Keyword(s):  
Surgical Stress ◽  
Exploratory Laparotomy ◽  
Morbidity And Mortality ◽  
P Value ◽  
Emergency Laparotomy ◽  
Emergency Setting ◽  
Operative Morbidity ◽  
The Mean ◽  
Preoperative Albumin

Background: Laparotomies are commonly performed surgeries in an emergency setting. The complications associated with these are a result of the activation of the surgical stress response, the magnitude and duration of which are proportional to the surgical injury. Albumin is an important negative phase reactant. This study was an attempt to evaluate the effectiveness of measurement of pre-operative albumin and the post-operative drop in albumin levels in the prediction of post-operative morbidity and mortality following laparotomy.Methods: Albumin levels of 50 patients undergoing emergency exploratory laparotomy in Victoria Hospital were measured pre and post operatively. The percentage drop in albumin levels was noted. The outcomes were noted and classified according to Clavein Dindo Classification. Unpaired t-test and ANOVA test was used for statistical analysis. A p value of <0.05 was considered statistically significant.Results: 62% of the patients had hypoalbuminemia preoperatively. 58% of patients had post-operative complications. The mean preoperative albumin levels for patients without complications was 3.83 while that for patients with complications was 2.78 (p<0.05). The mean percentage drop in albumin values was 9.66% for patients without complications while it ranged from 14.79 (Clavein Dindo 1) - 24.27 (Clavein Dindo 5) for patients with complications (p=0.047). A negative correlation was noted between the preoperative albumin values and the duration of hospital stay while the drop in albumin levels showed a positive correlation with the duration of hospital stay.Conclusions: Measurement of albumin levels pre-operatively and in the immediate post-operative period following laparotomy can prove as a useful tool and an early indicator of morbidity and mortality following laparotomy. 

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