Role of drains in cases of peptic ulcer perforations: comparison between single drain versus no drain

Background: Peptic ulcer perforation is one of the commonest causes of peritonitis and needs immediate surgical intervention after prompt resuscitation if mortality and morbidity are to be contained. Aims and objectives of the study was to compare role of Intra-abdominal drains prophylactically after plugging of these perforations single drain or no drain.Methods: In this study, we compared the relative safety and efficacy of putting single drain prophylactically near operation site or in natural abdominal fossae (hepato-renal pouch or sub hepatic) and no drain in cases of peritonitis due to peptic ulcer perforation. Study was done on 60 patients (one drain put in 30 patients Group A and no drain was put in other 30 patients of Group B). We handle the perforation after thorough peritoneal lavage with warm saline and metrogyl. All the perforation was closed by Grahm’s Patch.Results: No significant difference between drain and non-drain group as far age and sex concerned. Significant difference was seen in operative duration, hospital stay, wound dehiscence and post-operative fever, intraperitoneal collection or abscess formation. So use of drains are not effective in preventing post-operative infection rather there are chances of its blockage due to debris, intestine or omentum and tubes itself are source of infection as foreign body and there are chances of migration of bacteria from exterior to peritoneal cavity via these drains.Conclusions: Non drainage of peritoneal cavity after peptic ulcer perforation surgery is an effective method to reduce operative duration, hospital stay and wound dehiscence and post-operative pyrexia.

To Study the Effect of Ursodeoxycholic Acid in Lowering Neonatal Non – Hemolytic Hyperbilirubinemia: A Randomized Control Study

Hyperbilirubinemia is a common and in most cases, a benign problem in neonates. Conventional treatment for severe indirect hyperbilirubinemia consists of phototherapy and exchange transfusion. Phototherapy, which is the main treatment modality has its own side effects and it also upsets maternal and fetal interactions. So there is a need for adjuvant therapies to decrease duration of phototherapy and hospital stay. Objective: This study was planned to assess the role of UDCA in decreasing the duration of phototherapy in neonatal hyperbilirubinemia. Methods: Study setting: Pediatrics department, Bebe Nanki Mother & Child Care Centre, GMC Amritsar. Participants: 100 newborns with bilirubin levels in phototherapy range. Study design: Double blind, placebo controlled study. Participants were divided into two groups and UDCA (10mg/kg/d) and microcrystalline cellulose were given to group A and group B respectively. Outcome variables: Rate of fall of bilirubin levels in both the groups and total duration of phototherapy needed in both groups. Results: Mean duration of phototherapy was 36.26±8.41 hours in group A and 38.94±9.86 hours in group B. P value was 0.147 that is statistically not significant. Level of fall of bilirubin in both groups at 12hrly intervals were also compared and difference was not statistically significant. Conclusion: UDCA administration to the neonates receiving phototherapy does not hasten the fall in bilirubin levels and does not reduce the time of phototherapy significantly.