Abdominal wound closure in the presence of sepsis: our experience with the use of subcutaneous drain

Abstract

Objectives: Patients requiring surgery for secondary peritonitis demonstrate a significantly increased risk for incisional surgical site infection. This study aimed to evaluate the efficacy of subcutaneous wound drain post-laparotomy for contaminated surgical wounds.Design: This was a prospective comparative hospital-based study.Setting: Patients who had surgery for secondary peritonitis in Irrua Specialist Teaching Hospital were studied.Participants: Fifty patients aged 16 years and above who presented with secondary peritonitis.Intervention: Patients who met the inclusion criteria were randomized into two equal groups. Group A had a suction drain placed in the subcutaneous space after laparotomy while Group B did not.Main outcome measures: Development of incisional surgical site infection, wound dehiscence, and duration of postoperative hospital stay.Results: The incidence of incisional surgical site infection was significantly less in Group A (20%) than in Group B (68%). There was no case of wound dehiscence in Group A as against 3 (12%) in Group B. The difference was not statistically significant. The mean duration of hospital stay was significantly less with subcutaneous suction drain (8.96+2.81 Vs 14.04+8.05; p = 0.005).Conclusion: Subcutaneous suction drainage is beneficial in abdominal wall closure in cases of peritonitis as it significantlyreduces the incidence of incisional surgical site infection and the duration of postoperative hospital stay. Thereduction in surgical wound dehiscence observed in this study was, however, not statistically significant.