Abdominal toileting and drain, Beneficial/harmful, Exploratory laparotomy, Hemoperitoneum
Citation Information :
Mandal S, Karmakar C, Aishwarya A, Yadav N, Khatun A, Mandal A. The Role of Peritoneal Toileting and Abdominal Drainage during Exploratory Laparotomy for Hemoperitoneum due to Gynecological and Obstetrical Etiology. J South Asian Feder Obs Gynae 2022; 14 (4):429-434.
Aims and objectives: The role of abdominal drainage and peritoneal toileting/irrigation as beneficial or harmful, to compare between two groups, the evidence-based usefulness, and to evaluate the effect of postoperative morbidity.
Type of study: Prospective randomized control study, clinical trial, comparative study, research journal publication.
Materials and methods: After getting ethical approval, this research work was carried out in the Department of Obstetrics and Gynaecology in the Institute of Post-Graduate Medical Education and Research—Seth Sukhlal Karnani Memorial (SSKM) Hospital, Kolkata, West Bengal, India, with proper diagnosis, selection, and allocation of total 66 cases for exploratory laparotomy for hemoperitoneum in different gynecological and obstetrics indications was categorized into two cohorts of Gr-DI-n-33 (abdominal drainage and peritoneal toileting/irrigation) and Gr-Non-DI-n-33 (no abdominal drainage drain and peritoneal toileting/irrigation). As per the standard data collecting procedure, we had collected data from two groups [Gr-DI (n = 33) and Gr-NDI (n = 33)], the results of each group in the form of primary and secondary outcomes elaborated and the statistical significance analyzed and calculated with the help of GraphPad Software and expressed in Tables 1 to 3.
Result: The peritoneal irrigation and abdominal drainage in this operation (exploratory laparotomy for hemoperitoneum in different gynecological and obstetrics indications) are not required, and in fact, these procedures cause increased adverse events. In our study, it had been established that placement of such drain is not only beneficial but also unnecessary. At the same time, it had been revealed that it was time-consuming, prolongation of hospital time, and increased wound infection rate.
Conclusion: In this research study, there were minimal complications with the help of broad spectrum antibiotics and primary wound closure without peritoneal irrigation and abdominal drainage. With coverage of potent, high-level antimicrobial in such complicating operations, there was no need of such procedures.
Kumar M, Yang SB, Jaiswal VK, et al. Is prophylactic placement of drains necessary after subtotal gastrectomy? World J Gartroenterol 2007;13(27):3738–3741. DOI: 10.3748/wjg.v13.i27.3738.
Billroth T. Clinical surgery. London: The New Sydenham Society; 1881.Translated by Dent CT.
Delbert P. Researches experimentelle sur la lavage au peritoneum. Ann Gynekol Obstet 1889;32:165–197.
Conlon KC, Labow D, Smith A, et al. Prospective randomized clinical trial of value of intra peritoneal drainage after pancreatic resection. Ann Surg 2001;234:487–493 [Discussion: 493–494]. DOI: 10.1097/00000658-200110000-00008.
Alvarez Uslar R, Molina H, Torres O, et al. Total gastrectomy with or without drains. A prospective randomized trial. Rev Esp Enferm Diag 2005;97(8):562–569. DOI: 10.4321/s1130-01082005000800004.
Tsujinaka S, Kawamura YJ, Konishi F, et al. Pelvic drainage for anterior resection revisited: use of drain in anastomotic leak. ANZ J Surg 2008;78(6):461–465. DOI: 10.1111/j.1445-2197.2008.04535.x.
Suslu N, Vural S, Oncel M, et al. Is insertion of drains after uncomplicated thyroid surgery always necessary? Surg Today 2006;36(3):215–218. DOI: 10.1007/s00595-005-3129-x.
Morrissey AT, Chau J, Yunker WK, et al. Comparison of drain versus no drain in thyroidectomy: randomized prospective clinical trial. J Otolaryngol Head Neck Surg 2008;37(1):43–47. PMID: 18479627.
Tait L. Method of cleansing the peritoneum. Br Gynecol J 1887;3: 185–187.
Dougherty SH, Simmons RL. The biology and practice of surgical drains. Part II. Curr Probl Surg 1992;29(9):633–730. DOI: 10.1016/0011-3840(92)90028-2.
Mawalla B, Mshana SE, Chalya PL, et al. Predictors of surgical infections among patients undergoing major surgery at Bugando Medical Centre in Northwestern Tnazania. BMC Surg 2011;11:21. DOI: 10.1186/1471-2482-11-21.
Shahane V, Bhawal S, Lele U. Surgical site infection. A 1 year prospective study in a tertiary care center. Int J Health Sci (Qassim) 2012;6(1):79–84. DOI: 10.12816/0005976.
Levy M. Intra peritoneal drainage. Am J Surg 1984;147(3):309–314. DOI: 10.1016/0002-9610(84)90156-9.
Dougherty SH, Simmons RL. The biology and practice of surgical drain. Part-I. Curr Probl Surg 1992;29(8):559–623. DOI: 10.1016/0011-3840(92)90022-u.
Stone HH, Hooper CA, MIllikan WJ. Abdominal drainage following appendectomy and cholecystectomy. Ann Surg 1978;187(6):606–612. DOI: 10.1097/00000658-197806000-00004.
Menon MA, Menon MI, Donohue JH. Abdominal drain: a brief historical review. Ir Med J 2001;94(6):164–166. PMID: 11495230.
Pearl ML, Rayburn WF. Choosing abdominal incision and closure technique: a review. J Reprod Med 2004;49(8):662–670. PMID: 15457857.
Petrowsky H, Demartines N, Rousson V. Evidence based value of drainage in gastrointestinal surgery: a systemetic review and meta analysis. Ann Surg 2004;240(6):1074–1084. DOI: 10.1097/01.sla.0000146149.17411.c5.
Rather SA, Bari SU, Malik AA, et al. Drainage vs no drain in secondary peritonitis with sepsis following complicated appendicitis in modern era of antibiotics. World J Gatrointest Surg 2013;275(11):300–305. DOI: 10.4240/wjgs.v5.i11.300.
Memon MA, Memon B, Memon MI, et al. The uses and abuses of drains in abdominal surgery. Hosp Med 2002;63(5):282–288. DOI: 10.12968/hosp.2002.63.5.2021.
Ansari MM, Akhtar A, Haleem S, et al. Is there a role of abdominal drainage in primary repaired perforated peptic ulcers? J Exp Integr Med 2011;2(1):47–54. DOI: 10.5455/jeim.201111.or.015.
Pai D, Sharma A, Kanungo R, et al. Role of abdominal drains in perforated duodenal ulcer patients:a prospective control study. Aust NZ J Surg 1999;69(3):210. DOI: 10.1046/j.1440-1622.1999.01524.x.
Magarey CJ, Chant ADB, Rickford CRK, et al. Peritoneal drainage and systemic antibiotics after appendectomy. Lancet 1971;2(7717):179–182. DOI: 10.1016/s0140-6736(71)90894-4.
Haller JA, Shaker IJ, Donahoo JS, et al. Peritoneal drainage versus non-drainage for generalized peritonitis from rupture appendicitis in children: a prospective study. Ann Surg 1773;177(5):595–600. PMID: 4704043.
Dandapat PM, Panda C. A perforated appendix: should we drain? J Indian Med Assoc 1992;90(6):147–148. PMID: 1522303.
Sagar PM, Couse N, Kerin M, et al. Randomized trial of drainage of colorectal anastomosis. Br J Surg 1993;80(6):769–771. DOI: 10.1002/bjs.1800800640.