Résumé
Background: Surgical site infection is a common cause of morbidity for the operated patients. Hence a cost effective and simple method was formulated and studied on cases of laparotomy and appendicectomy patients which can be categorized as dirty and contaminated wounds. Materials and methods: 25 cases and adequately matched controls were selected from patients who underwent laparotomy or appendicectomy which can be categorized as dirty or contaminated wounds. Cases were given local application Inj. Amikacin over the subcutaneous plane preoperatively and for the subsequent three post-operative days through a subcutaneously placed feeding tube along with systemic iv antibiotics. The control patients only received systemic IV antibiotics. ASEPSIS scoring was used to grade the post-operative surgical site infection in the cases and the corresponding controls, at the end of the first and second week after surgery. Various criterions were specifically evaluated such as the isolation of microbe from the wound site or the requirement of change of antibiotic at the end of the 1st or 2nd week and the tendency of prolonged stay in the hospital for more than 2 weeks. Results: It was observed that the cases that received the local Amikacin application as an adjuvant to systemic antibiotic showed significantly lesser incidence and/ or grading of SSIs in the first week and A.K. Rajendran, C. Arun Babu, Gnana Sezhian. To evaluate efficacy of local Amikacin therapy as an adjuvant to parenteral antibiotics in control of surgical site infection compared to parenteral antibiotic alone in a tertiary care centre. IAIM, 2018; 5(2): 64-71. Page 65 also lesser, but not statistically significant reduction of SSIs in the second week. The incidence of antibiotic change, hospital stay and isolation of microbe from the wound site was statistically found be to lesser in the study group compared to their controls. Conclusion: It is observed that the local therapy as an adjuvant is cost effective and without any significant local or systemic adverse effects in the prevention of SSIs in dirty and contaminated patients. But it was also observed that it did not have sustained effect for prolonged period beyond its time of administration (as evidenced by its lesser effect in the second week after surgery). It may be suggested that a further combination of suction drainage of the subcutaneous DT along with local antibiotic treatment may have added advantage in further preventing SSIs.
Résumé
Context: Hernia is defined as an abnormal protrusion of viscus through normal openings in the body. The lowness of pubic tubercle is associated with narrow origin of internal oblique muscle from lateral inguinal ligament which fails to protect the deep inguinal ring. The structural anatomy is altered i.e. the obliquity of the inguinal canal gets decreased, arching of conjoint tendon gets narrowed, and the shutter mechanism of internal oblique gets diminished leading on to the ineffective defence mechanism ending up in the development of inguinal hernia. Aim: To find out the prevalence of inguinal hernia in low lying pubic tubercle at our tertiary hospital setup. Materials and methods: The ST and SS Line measurements of the case were compared with those of controls to find out whether there was tendency of having low lying pubic tubercle in case of inguinal hernia. An attempt was also made to observe any correlation between ST segment and height, weight of the patients. The quantitative variables were summarized as mean and standard deviation while qualitative variables as percentage and proportion. To the statistical significance between the two independent two groups student ‘t’ test while in more than two groups ANOVA (one way) was applied and to show correlation Pearson’s correlation applied. The difference was considered significant when p value was less than 0.05. The statistical package used was SPSS 23. Results: This study showed that the people with low lying pubic tubercle have a reduction in efficiency of shutter mechanism of inguinal canal leading to the development of inguinal hernia. Conclusion: Group of people with low lying pubic tubercle are at high risk of developing inguinal hernia.