A comparative study of negative suction drainage in inguinal hernia operations at Saraswathi Institute of Medical Sciences, Pilkhua, Hapur Uttar Pradesh

Background: The inguinal area is the weakest region of the abdominal wall. So, this is the most common site for the development of hernias. Inguinal hernias are the commonest amongst all the hernias and hernia repair is the most frequently done operation worldwide. There is no agreement among surgeons regarding the need for drains. Some use sparingly and some use it routinely. This study aims to evaluate the use of negative suction drain in inguinal hernia surgery.Methods: We studied sixty patients of inguinal hernias both direct and indirect for one year and followed up for next 1-2 years. This prospective study aimed to see the effect of negative suction drainage in hernia surgery.Results: Both the groups did well postoperatively. It was beneficial to put a negative suction drain in those patients who had a bigger hernia, fatty patients with the thick fatty lower abdominal wall and older patients.Conclusion: It is advisable to put a negative suction drain in inguinal hernia surgery and strongly advocated if the dissection had been difficult, old patients and fatty lower abdominal wall

Sevoflurane Preconditioning and Total Knee Arthroplasty Bleeding: A Randomized Controled Trial

Background: Total knee arthroplasty (TKA) is a highly complex and effective surgery even though its perioperative bleeding may increase the need for blood transfusion and its associated infection risk, cardiovascular overload, increased costs, and mortality. As tourniquet reduces intraoperative bleeding it may be associated with postoperative bleeding, venous thrombosis, and distal ischemia. The reperfusion may trigger a local and systemic inflammatory response. Anesthetic preconditioning (APC) with sevoflurane minimizes ischemia-reperfusion syndrome (I/R). This study evaluated the effects of APC with sevoflurane on perioperative bleeding in TKA.Methods: We allocated 30 patients into two groups: a sevo group (sevoflurane 2% for 15 minutes before the tourniquet) and a control group (propofol infusion). Laboratory tests were collected right before the tourniquet (LAB PRE, in the operating room) and after its release at four moments: LAB POST (immediately after), LAB 2 (two hours after), LAB 12 (12 hours after), and LAB 24 (24 hours after). The volume of the suction drain was measured at one, two, 12, and 24 hours after the end of the surgery. Antifibrinolytics were not administered.Results: There was no statistically significant difference in bleeding-related variables, such as drained volume and hemoglobin and hematocrit measurements. Drainage volume was higher in the first two hours after the procedure, while hematocrit decreased pre- to post-operatively and between two- and 12-hours post-procedure.Conclusion: Sevoflurane as an anesthetic preconditioning did not reduce postoperative bleeding in TKA surgery.Trial Registration: ClinicalTrials.gov – NCT03379103; December 20, 2017.

Limberg flap as a Primary Treatment for Pilonidal Sinus at Nepal Mediciti Hospital: A Single Unit Experience

INTRODUCTION: Pilonidal Sinus is a common condition with estimated incidence of 260 per million population with more male predilection and is often seen in sacrococcygeal area but has also been described in other areas with hair. The Limberg rhomboid flap was designed by Limberg in 1946 for the closure of a sixty degree rhombus shaped defect with a transposition flap. We would like to share our single unit experience of Rhomboid Limberg flap for Pilonidal sinus in our hospital. METHODS: This is an ongoing prospective descriptive study in the Department of General Surgery and Digestive Diseases of Nepal Mediciti Hospital from October 2018. The demographic of the patients, presenting symptoms, duration of symptoms and previous interventions are recorded and the Rhomboid Limberg flap surgery is done under regional or general anesthesia in prone position. The patient is given intravenous antibiotic and is instructed to sleep laterally or in prone position for 24 hours. The dressing is removed and the wound is inspected for flap status in the next morning. The patient is discharged on 1st post-operative day on oral antibiotics for 7 days and is followed on 7th post-operative day for removal of suction drain and alternate sutures in the skin and remaining sutures are removed on 10th post-operative day. RESULTS: We have done 28 cases of Limberg flap for Pilonidal Sinus from October 2018 to December 2020 of which 24 were male patients. None of our patients had flap necrosis. One patient presented with accidental removal of suction drain on 5th postoperative day, however he didn’t develop any wound related complication. One patient had superficial wound dehiscence on 10th post-operative day which healed on its own with dressing. One patient developed seroma from 5th postoperative and was managed with dressing and antibiotics and it healed in 2 weeks. None of our patients have developed recurrence and their wounds have healed satisfactorily with minimal scarring and pain. All the patients were able to resume their regular activities within 21 days. All except 2 patients were satisfied with cosmetic outcome. CONCLUSION: The Limberg flap is ideal treatment for pilonidal sinus with minimal postoperative pain, short hospital stay, few complications, rapid return to normal activities, good cosmesis, and a low recurrence rate with short learning curve for young surgeons. Hence, Limberg flap should be routinely used as primary treatment for pilonidal sinus.

CURRENT RESULTS OF CONVENTIONAL LUMBAR ARTHRODESIS

ABSTRACT Objective: To evaluate the peri- and postoperative results and clinical repercussions in patients undergoing decompression surgery and single-level lumbar arthrodesis using the traditional technique (OTLIF) and to compare with the results of minimally invasive techniques (MITLIF) described in the literature. Methods: Our sample consisted of 22 patients who underwent TLIF surgery using the open technique (OTLIF) in the period October 2019 to January 2021, in our hospital. We compared the patients’ functional clinical results using the Oswestry scale in the preoperative period and 15 days after surgery, analyzed variables related to the perioperative period: surgery time, length of hospital stay, blood loss, use of a suction drain, and admission to the ICU, and compared these with the results reported in the literature for patients treated by the MITLIF technique. Results: The average age was 48.95 years and the most operated level was L4-L5 (55%). The average surgery time was 112.63 min. We did not use a suction drain in the postoperative period, there was no need for a blood transfusion in any patient, and no patient was admitted to the ICU. The average hospital stay was 1 day. Regarding the Oswestry Disability Index, the mean preoperative score was 44.73 and after 15 days, it was 24.05. Conclusions: surgical treatment using the OTLIF technique for single-level lumbar degenerative disease showed largely positive results, with improvement in disability scores, short hospital stay and low incidence of complications. When properly indicated, OTLIF is an excellent and safe option for the treatment of degenerative lumbar disease. Level of evidence IV; Case series study.

Modified Incisional Negative Pressure Wound Therapy Increases Seroma Evacuation: An Ex Vivo Model

Background. Incisional negative wound pressure therapy (iNPWT) is a relatively novel dressing technique with the aim of reducing postoperative wound infections and dehiscence in high-risk wounds after all kinds of surgical procedures. There is a lack of theoretical knowledge about the way those dressing would ameliorate wound healing. One aspect is the reduction of superficial tension, but significant remaining seroma might still cause deep wound infections. The aim of this study was the evaluation of technical modifications of the standard iNPWT dressing to increase seroma evacuation. Methods. iNPWT dressings were applied on the porcine abdominal wall, and an incremental pressure ramp from 50 to 200 mmHg was performed. The resulting wound pressures were measured using (i) balloon manometry and (ii) esophageal manometry catheter. Seroma evacuation was analyzed with a seroma model. All measurements were performed with (i) standard iNPWT dressing, (ii) wound gauze diverted through the incision, and (iii) placement of suction drain tube into iNPWT. Results. Due to the modifications of the iNPWT dressing, the vacuum applied by the iNPWT dressing could be transferred into the wound and was not only restricted to superficial layers. More importantly, placement of wound gauzes or suction drain tubes led to complete extraction of wound seroma. The placement of the suction drain tube showed the best combination of increased intrawound pressure as well as seroma evacuation. Conclusion. Addition of a suction drain tube to the iNPWT dressing leads to an improved function of the iNPWT dressing in our ex vivo model.

TP7.2.1 Outcomes of Modified Karydakis flap in the surgical management of sacrococcygeal pilonidal disease: A single surgeon’s experience

Aim To determine the incidence of post-operative complications of patients with sacrococcygeal pilonidal disease who were treated with the Modified Karydakis flap with a specific management bundle. Primary outcomes assessed included the post-operative incidence of seroma, haematoma, SSI, deep SSI, wound dehiscence, re-admissions, return to theatre and flap necrosis. Secondary outcome evaluated was recurrence at 6 month follow up. Method It was a retrospective analysis of a single surgeon’s (FA’s) practice results of Modified Karydakis flaps on patients with sacrococcygeal pilonidal disease who were managed according to a specific protocol. Data was collected between June 2017 and June 2020. 96 patients were analysed, of which 9 were excluded as they had excision without closure. Pre, per and post-operative management for the remaining 87 patients was according to a standardised protocol. Data was collected from patient’s notes and from prospectively and retrospectively maintained patient data bases (Theatre System, Medway). Results Primary outcomes: • Seroma: 8/87 (9.2%) • Haematoma: 1/87 (1.2%) • SSI: 10/87 (11.5%) • Deep SSI: 4/87 (4.6%) • Superficial dehiscence: 7/87 (8.0%) • Re-admission: 4/87 (4.6%) • Return to theatre: 0 (0%) • Flap necrosis: 0 (0%) Secondary outcome: • Recurrence at 6 months: 2/87 (2.3%) Conclusions Good surgical results can be obtained with Modified Karadakis flap, provided meticulous surgical technique is applied. Placement of a suction drain for a minimum of 72 hours reduces incidence of post-operative haematoma and seroma formation. Three post-operative doses of broad spectrum intravenous antibiotics followed by 5 days of oral antibiotics helps reduce post-operative infections.

Efficacy of Subcutaneous Closed Suction Drain in Reduction of Postoperative Surgical Site Infection

Background Surgical site infections (SSIs) are the infections of wound after an invasive operative approach. It remains to be a major morbidity for patients undergoing surgeries although there have been tremendous improvements in the surgical techniques.Different interventions to suppress the selective serotonin reuptake inhibitors have been proposed. Many of them have been routinely used by surgeons like minimizing shaving, hand washing, and preoperative antibiotics and these are well accepted. Drains are used in major abdominal surgeries, hernia repairs, breast surgeries reducing collections in closed areas.1 Hematoma, serous fluid, and dead space in surgical incision wounds raise the risk of infection as they serve as the platform for microbial growth. Studies have proved that the usage of subcutaneous drains has lowered the chances of infection. Results The patients in the case group had lower incidence of SSI compared with the control group. The patients in the case group had subcutaneous drain which drained any collection that developed in the subcutaneous space. When the incidence of SSI was compared between the emergency cases and elective cases, the emergency cases showed higher propensity for SSI and increased rate for patients who had co-morbidities like diabetes mellitus, hypertension, etc. The most common organism isolated from the SSI was found to be Escherichia coli. It was also noted that the mean number of days of hospital stay was comparatively higher for the patients who developed SSI compared with patients who did not develop SSI. Conclusion Thus the presence of SSI adds morbidity to the patient and the patients who undergo major surgeries are likely to develop SSI postoperatively. The presence of subcutaneous closed suction drain helps in reducing the SSI to a certain extent.

Compare the Frequency of Surgical Site Infections in Patients Undergoing Hip Surgery with Closed Suction Drain Placed At Surgical Site and Without Drain

Introduction: Hip trauma is a debilitating event that leads to a major limitation in patient’s functional ability. The incidence of hip fractures increases with advancing age and are more common in old age individuals. Closed-suction drainage has been routinely used in total hip arthroplasty to prevent hematoma formation and surgical site infections (SSI). Objective: To compare the frequency of surgical site infections in patients undergoing hip surgery with closed suction drain placed at surgical site and without drain. Study Design: Randomized controlled trial. Place and Duration: The study was completed at department of Orthopedic Surgery Unit III, Bolan Medical College Hospital Quetta, Pakistan. The duration of study was from 1-April-2016 to 31-October-2017. Subjects and Methods: A total number of 176 patients who underwent hip arthroplasty were included in this study. Group A (n=88) patients underwent hip surgery with placement of drain and Group B patients underwent hip surgery without the placement of drains. Data analysis was carried out using SPSS v20.0. Chi-square test was applied to compare surgical site infections in drain group and without drain group. Effect modifiers were controlled by stratification. Post stratification Chi-square test was applied taking P-value <0.05 as significant. Results: The mean age of patients in this study was 42.26 (SD 9.86) years. There were 135 males (76.7%) patients in this study and 41 (23.3%) female patients. The mean duration of fracture was 39.41 (SD 7.74) days. There were 63 (35.8%) patients who presented with greater/lesser trochanteric fractures, 64 (36.4%) presented with sub-trochanteric fractures and 49 (27.8%) were presented with inter-trochanteric fractures. SSIs occurred in 7 patients in whom drain was inserted after surgery and in only 2 patients in whom drain was not inserted (p-value 0.08). There was no effect of confounder variables on the occurrence of SSIs. Conclusion: The risk of surgical site infections is same in patients undergoing hip surgery with closed suction drain placed at surgical site and without drain. Keywords: Hip fractures, Hip arthroplasty, Closed suction drains, Surgical site infections.

269 Outcomes of Modified Karydakis Flap in The Surgical Management of Sacrococcygeal Pilonidal Disease: A Single Surgeon’s Experience

Aim To determine the incidence of post-operative complications of patients with sacrococcygeal pilonidal disease who were treated with the Modified Karydakis flap with a specific management bundle. Primary outcomes assessed included the post-operative incidence of seroma, haematoma, SSI, deep SSI, wound dehiscence, re-admissions, return to theatre and flap necrosis. Secondary outcome evaluated was recurrence at 6 months follow up. Method It was a retrospective analysis of a single surgeon’s (FA’s) practice results of Modified Karydakis flaps on patients with sacrococcygeal pilonidal disease who were managed according to a specific protocol (fig. 1). Data was collected between June 2017 and June 2020. 96 patients were analysed, of which 9 were excluded as they only had excision without closure. Pre, per and post-operative management of the remaining 87 patients was according to a standardised protocol (fig. 1). Data was collected from patient’s notes and from prospectively and retrospectively maintained patient data bases (Theatre System, Medway). Results Primary outcomes: Secondary outcome: Conclusions Good surgical results can be obtained with Modified Karadakis flap, provided meticulous surgical technique is applied. Placement of a suction drain for a minimum of 72 hours reduces incidence of post-operative haematoma and seroma formation. Three post-operative doses of broad-spectrum intravenous antibiotics followed by 5 days of oral antibiotics helps reduce post-operative infections.

A COMPARATIVE STUDY OF SUBCUTANEOUS SINGLE CLOSED SUCTION DRAIN VERSUS SIMPLE CLOSURE IN EMERGENCY MIDLINE LAPAROTOMY WOUNDS

Wound healing is major concern after surgical procedure, because of its association with quality of life and morbidity of patients. Infections that occur in the wound created by an invasive surgical procedure are generally referred to as Surgical Site Infections (SSIs).. Patients requiring Emergency laparotomy procedure has increased risk of surgical site infection and delayed wound healing. Complications following the closure of abdominal layers after correcting the pathology and peritoneal washings are surgical site infections, wound dehiscence, burst abdomen, wound seroma and wound hematoma. Negative suction in the subcutaneous plane decreases infection by removal of serum or debris and by elimination of dead space in the plane. This study is to compare the subcutaneous single closed suction drain and conventional simple closure of skin and subcutaneous tissue in emergency laparotomy cases.