Irrigation suction therapy reduces post-hysterectomy surgical site infection in middle-aged and older diabetic women: A randomized prospective study.

OBJECTIVE: To determine whether or not closed wound irrigation and suction therapy can reduce post-hysterectomy surgical site infections in middle-aged diabetic women without increasing pain, causing complications or lowering patient satisfaction. Methods: The prospective randomised controlled study was conducted from April 2017 to March 2022 at Lady Willingdon Hospital, Lahore, Pakistan, and comprised women aged >40 years with body mass index >25kg/m2 who were scheduled for hysterectomy. The subjects were randomised into intervention group A and control group B. In the irrigation and suction group A, subcutaneous drains were inserted for daily closed wound saline irrigation followed by full-day suction for 3 days. In control group B, wound closure was done without drains and irrigation and suction. Wounds were assessed daily during hospitalisation and at 4, 8 and 12 weeks postoperatively. Primary outcome was surgical site infection rate, fever, white blood cell count, pain score and length of hospital stay. Secondary outcomes were readmission rate, wound pain during follow- up other complications and patient satisfaction. Data was analysed using SPSS 20. RESULTS: Of the 334 patients, 300(89.8%) were included; 150(50%) in group A with mean age 56.66±9.264 years, and 150(50%) in group B with mean age 55.77±9.394 years. However, the study was completed by 274(91.3%) subjects; 138(50.4%) in group A and 136(49.6%) in group B. Group A had significantly fewer surgical site infections (p<0.0001), lower white blood cell count (p<0.0001), fever (p<0.001) and pain scores (p<.0001), shorter hospital stay (p<.0001) and higher patient satisfaction (p<.0001) compared to group B. Follow-up pain scores and other complications did not differ significantly between the groups (p>0.05). Conclusion: Irrigation and suction strategy reduced surgical site infection rates without increasing pain, causing complication or compromising patient satisfaction.

A randomized controlled trial of cystoinflation to prevent bladder injury in the adhesive disease of multiple caesarean sections.

Caesarean sections carry the risk of urinary bladder injury due to formation of adhesions obscuring pelvic planes. Visualizing bladder during retro-fill (cystoinflation) makes it recognizable as it rises into the abdomen taking a tense rounded contour. We conducted a prospective randomized controlled trial to find out whether improved identification of bladder margins by cystoinflation could decrease bladder injury rate and blood loss without causing urological complications. This study included 214 healthy women with previous operative deliveries undergoing elective caesarean section and found to have dense pelvic adhesions. The subjects were randomly allocated into cystoinflation and control groups. Adhesiolysis was performed using bladder retro-fill with 300 cc saline in cystoinflation group, and without retro-fill in control. The bladder injury rate was significantly lower in cystoinflation group compared to control (2.8% vs 20.6%, P < .0001) with lesser blood loss in cystoinflation group (585.33 cc vs 797.10 cc, P < .0001). Mean operative time was similar in both groups. Urinary tract infection and micturition problems occurred more frequently in control group than cystoinflation group (16.8% vs 1.9%, P = .001 and .47 ± 1.63% vs 077 ± .633%, P = .021 respectively) with fistula in one subject compared to none in cystoinflation group. In this study, cystoinflation was effective to significantly reduce bladder injury rate and blood loss. This technique may also prove useful in the fields of surgery, urology and urogynecology.