A Study of subcutaneous negative pressure closure versus simple closure in laparotomy wound of Ileal perforation.

ABSTRACT

Background: Ileal perforation is a surgical emergency. It has very high morbidity and also mortality. As patients are commonly presented with peritonitis and fecal contamination, wound infection rate is very high. Wound infection is major issue in such condition, where related complications are frequently seen. If wound infection is controlled then many complication related to it could be prevented. And it finally affects the morbidity of patient. Aims & Objective: To compare a role of negative pressure closure versus simple closure of laparotomy wound in ileal perforation. Material and Methods: 60 cases, in period of Nov 2012 to June 2013 at SMIMER hospital, Surat presented with ileal perforation were included in the study. After a surgical treatment of all cases, they were divided in two groups. One group A was closed with Negative pressure closure (By putting subcutaneous Negative Suction Drain) at the time of laparotomy wound closure and other group B with simple closure. And the outcome compared in the form of wound infection, hospital stay, second surgery and morbidity. Total 10 cases were expired within 3 day after surgery, excluded from study (6 from group A and 4 from group B). Results: In study average rate of wound infection (SSI-Surgical Site Infection) was 25% (8/24) in group A and 57.7% (15/26) in group B. Average hospital stay for group A was 12 day and 18 day for group B. Second surgery needed in 4 cases in group A and for 8 cases in group B. Second surgery was in form of secondary suturing of wound or wound dehiscence and burst abdomen repair. Mortality in group A was 6 and in group B was 4 but it was not related to SSI because all death occurred within 3 days after surgery mainly due delay presentation and to poor general condition pre-operatively. Overall morbidity was less with Negative pressure closure in compare to simple closure and it highly affects the morbidity and somehow mortality also. Conclusion: One of the common complications of typhoid is typhoid ulcer and perforation. There is more chance of wound infection in such laparotomy wound because of highly contamination of the peritoneal fluid with fecal material. Such wound constantly leads to serous discharge and bacterial colonization. But negative pressure closure removes that collection and avoids wound infection. And it helps in reducing hospital stay and morbidity.