• Nu S-Au Găsit Rezultate

View of Drain or not to drain in Elective Gastrointestinal Surgery -A Prospective Cross Sectional Study

N/A
N/A
Protected

Academic year: 2022

Share "View of Drain or not to drain in Elective Gastrointestinal Surgery -A Prospective Cross Sectional Study"

Copied!
15
0
0

Text complet

(1)

Drain or not to drain in Elective Gastrointestinal Surgery -A Prospective Cross Sectional Study

1)Anurag Bhattacharjee

Junior Resident, Department of Surgery, Jawaharlal Nehru Medical College Wardha, Datta Meghe University of Medical Sciences, Wardha, Maharashtra, India

2) Dr. Harshal Ramteke

Associate Professor, Department of Surgery, Jawaharlal Nehru Medical College Wardha, Datta Meghe University of Medical Sciences, Wardha, Maharashtra, India

3) Dr. Meenakshi Yeola (Pate)

Professor & Head of department , Department of General Surgery, Jawaharlal Nehru Medical College Wardha, Datta Meghe University of Medical Sciences, Wardha, Maharashtra, India

4)Dr. BhavaniprasadKalagani

Senior Resident, Department of Surgery, Jawaharlal Nehru Medical College Wardha, Datta Meghe University of Medical Sciences, Wardha, Maharashtra, India

Corresponding Author- Dr. Harshal Ramteke

Associate Professor, Department of Surgery, J. N. Medical college Wardha, Datta Meghe University of Medical Sciences, Wardha, Maharashtra, India

[email protected] Abstract-

Introduction-

Drains, its usage and needs have always been a topic of debate. There are many in the surgical profession like John yates who believed that the concept of prophylactic intra- peritoneal drainage is not necessary and should be changed with changing times.Furthermore they have also openly opined their views but there are also those who wish continue to remain silent on this issue and continue to utilize drain as a safety valve or as a preventive measure due to their consciences rather than any scientific backing for the same. Regrettably the concept of prophylactic drainage has not been scientifically studied in great detail. So the importance of overall use of the prophylactic drain in abdominal surgeries remains a topic of further study. Despite this , surgeon’s still employ prophylactic drain application in abdominal surgeries on regular basis thus adhering to the values of Tait. . Hence there continues to remain a dispute regarding the usage of drains. Therefore, the objective of this study was to focus the usefulness of the prophylactic drainage of peritoneum after abdominal surgeries.

Methods-All the abdominal surgery cases of both sexes admitted in surgical ward through OPD or via emergency basis requiring elective abdominal surgeries for various abdominal pathologies were evaluated with detailed history. This is prospective cross sectional study.

(2)

Result- There is evidence of level 1a that drains do not reduce complications after hepatobiliary surgery, colorectal surgeries with primary anastomosis and appendectomy for any stage of appendicitis. Drains were indirectly responsible for increasing the morbidity and post-operative recovery period.

Discussion- Practice of prophylactic drain placement in abdominal surgeries was associated with higher morbidity and mortality.

Conclusion- Many elective GI operations can be performed safely without prophylactic drainage. Drains should be omitted after hepatobiliary surgery, colorectal surgeries with primary anastomosis and appendectomy (recommendation grade A). Furthermore, there should me studies carried out to understand the role of drains.

Key words– Drains, Non- Drain group, Gastrointestinal surgery , Drain site complications Background –

What is a Surgical Drain?

The Oxford English dictionary defines a drain as ―a channel by which surplus liquid is drained or gradually carried off‖(1). While this statement can be applied to a surgical drain, however what the second half of the definition that is offered by online encyclopedia is far away from the truth. Wikipedia in year 2007 stated that ―application of surgical drains helps in faster wound healing and prevents further infection‖. Regrettably this statement has been ingrained in the minds of many surgeons (2).

In the field of surgery, the usage of drains has always been an important component, though the field has expanded into multiple super and sub-specialties, it continues to remain an important modality(3). Initial surgeons came out with different variants of it though rudimentary but it formed the base on which the current models are based. As many times fear precedes over logic in such decisions. No one will question the need for drainage of unwanted collections, nobody can directly say yes or no to precautionary drain usage and hence we are left with quote of Tait(4) –Whenever there is doubt, the drain is to be put. This illogically logic statement that is still whispered today, but the query will be removed one day.Surgeon’s are using prophylactic drainage on daily basis after abdominal procedures after its advantages were shown by Sims(5). But this theory was rejected by many in the surgical society. Doctors who prefer to use drains argue that drainage of the peritoneum can detect early problems at a fast rate thus providing an early option in helping improve lives while people who were not in favour say that drainage of the peritoneum is not possible as mentioned by. Hence it is of no use. As quoted by John yates in his paper published in the year 1881 for which he received Senn medal accurately described the issue of peritoneal drainage, the problem that persist even today(6). He concluded that it is not possible to drain the peritoneal cavity completely as it is physiologically and mechanically against the body mechanics to allow the peritoneum to be completely drained. Hence there continues to remain a dispute regarding the usage of drains. Therefore, the objective of this study was to focus the usefulness of the prophylactic drainage of peritoneum after abdominal surgeries.

(3)

MATERIALS AND METHODS

The present study was undertaken in the department of surgery, Jawaharlal Nehru Medical College, Wardha in collaboration with Datta Meghe Medical College Hingana, Nagpur, Datta Meghe Institute of medical science (DMIMS), Sawangi, Meghe, Wardha, Maharashtra India.

Source Of Data:- Department Of Surgery AVBRH Method Of Collection Of Data:-

All the elective abdominal cases of both sexes admitted in surgical ward through out door patient(OPD) or in emergency requiring elective abdominal surgeries for various abdominal pathologies will be evaluated with detailed history, examination, pathology, surgical procedure underwent, postoperative course, various complications, duration of hospital stay and follow up to 1month will be documented.

They will receive similar postoperative antibacterial protocol and other treatment (nil per orally, Iv fluids, analgesics). These cases were grouped into no- drain and drain group.

Type of Study: Prospective Observational Study Sample Size :90

Duration Of Study : September 2018 To October 2020 Inclusion Criteria :

All The Operated Cases for Various Intra-Abdominal Diseases On Elective Basis Were Included.

Exclusion Criteria :

1. Medical diseases &/or medications which could interfere with the immune competency of the patient like diabetes mellitus or steroid use.

2. Patients<6yrs of Age

3. Patients Underwent Abdominal Surgeries (Elective) That Died Within 48hrs After Surgery.

4. Emergency abdominal surgeries STATISTICAL ANALYSIS

Processing of the collected data was done using SPSS 16.0. An expository statistical process was done, the frequency, percentage, mean, and standard deviation were calculated for evaluation of co-relation between the parameters, t-test, variance . Outcome was evaluated in 95% confidence interval and p<0.05 significance level.

Results & Observation tables-

(4)

Table 1: Age distribution of patients

In the present study of 90 patients, it was observed that the mean age of presentation was 45.21±13.88 (11-74 years), the youngest patient being 11 years old and the oldest patient being 74 years old

Table 2: Gender wise distribution of patients

Gender Drain Non Drain Total χ2-value

Male 34(68%) 29(72.50%) 63(70%)

0.21 p=0.64,NS

Female 16(32%) 11(27.50%) 27(30%)

Total 50(100%) 40(100%) 90(100%)

≤20 yrs 21-30 yrs 31-40 yrs 41-50 yrs 51-60 yrs >60 yrs

2% 12% 20% 26% 20% 20%

5% 12.50% 32.50% 20% 22.50% 7.50%

% of patients

Age Group(years) Drain Non Drain

Age

Group(yrs) Drain Non Drain Total χ2-value

≤20 yrs 1(2%) 2(5%) 3(3.33%)

4.77 p=0.44,NS 21-30 yrs 6(12%) 5(12.50%) 11(12.22%)

31-40 yrs 10(20%) 13(32.50%) 23(25.56%) 41-50 yrs 13(26%) 8(20%) 21(23.33%) 51-60 yrs 10(20%) 9(22.50%) 19(21.11%)

>60 yrs 10(20%) 3(7.50%) 13(14.44%)

Total 50(100%) 40(100%) 90(100%)

Mean±SD 47.10±13.44 42.85±14.22 45.21±13.88

Range 16-68 11-74 11-74

(5)

 In our study, it was observed that out of 90 cases studied 63(70%) were male patients and 27(30%) were female patients. The M: F ratio was 2.33:1 .

Table 3: Distribution of patients as Drain placement/ Non-Drain placement

No of patients Percentage

Drain 50 55.56

Non Drain 40 44.44

Total 90 100

In our study, total number of patients (90) were divided into drain & non-drain group. The drain group had 50(55.56%) patients while the non-drain group had 40(44.44%) patients.

Table 4: Distribution of patients in two groups according to type of surgery

Type of surgery Drain Non Drain Total χ2-value Abdominal Wall 9(18%) 9(22.50%) 18(20%)

4.89 p=0.67,NS Upper gastrointestinal 6(12%) 4(10%) 10(11.11%)

Appendicular Surgery 2(4%) 5(12.50%) 7(7.78%) Hepatobilliary surgery 6(12%) 6(15%) 12(13.33%)

Pancreatic 6(12%) 5(12.50%) 11(12.22%)

Splenic 4(8%) 4(10%) 8(8.89%)

Colorectal 10(20%) 4(10%) 14(15.56%)

Urological 7(14%) 3(7.50%) 10(11.11%)

Total 50(100%) 40(100%) 90(100%)

In our study total, 90 patients were observed which were divided into 8 groups depending upon the type of surgery they underwent. The majority of patients underwent abdominal wall surgeries 18(20%) followed by colorectal surgeries 14 (15.56%), Abdominal wall surgeries 18(20%), Upper gastrointestinal surgeries 10(11.11%), Appendicular surgeries 7(7.78%), Hepatobiliary surgery 12(13.33%), Colorectal surgeries 14(15.56%), Pancreatic 11(12.22%), Splenic 8(8.89%), Urological 10(11.11%).

Table 7: Distribution of Drain/Non-Drain patients according to length of hospital stay

Length of hospital

stay Drain Non Drain Total χ2-value

0-10 days 4(8%) 11(27.50%) 15(16.67%) 7.60 p=0.10,NS

11-20 days 19(38%) 14(35%) 33(36.67%)

(6)

21-30 days 21(42%) 12(30%) 33(36.67%)

31-40 days 4(8%) 3(7.50%) 7(7.78%)

41-50 days 2(4%) 0(0%) 2(2.22%)

Total 50(100%) 40(100%) 90(100%)

Mean±SD 22.20±9.61 17.22±8.49 19.98±9.41

In the present study of 90 patients, the mean length of hospital stay in the drain group was 22.20±9.61 days with 42%of patients seen in the drain group between 21-30 days. While in the non- drain group it was 17.22±8.49 days with 35% patients seen in the non-drain group between 11-20days. p=0.10 which is statistically insignificant.

Table 8: Distribution of patients in two groups according to post-operative surgical wound site complications.

Wound site

Complication Drain Non Drain Total χ2-value

Yes 10(20%) 5(12.50%) 15(16.67%)

0.90 p=0.34,NS

No 40(80%) 35(87.50%) 75(83.33%)

Total 50(100%) 40(100%) 90(100%)

 In our study conducted on 50 patients in the drain group,10 (20%) of patients had wound site infection, while among the 40 non-drain patients only 5 (12.50%) of patients had wound site infection. P-value is 0.34 which is statistically insignificant.

Among patients with drain, 8 patients developed wound site infection while 2 patients developed wound dehiscence.

Table 9: Distribution of patients in two groups according to post-operative septic complication.

Septic infection Drain Non Drain Total χ2-value Respiratory

Infection 1(2%) 0(0%) 1(1.11%)

5.42 p=0.24,NS

Fever 1(2.50%) 0(0%) 1(1.11%)

Pleural Effusion 4(8%) 0(0%) 4(4.44%)

Septicaemia 4(8%) 3(7.50%) 7(7.78%)

Not Any 41(82%) 36(90%) 78(86.67%)

Total 50(100%) 40(100%) 90(100%)

 In our study, out of 50 patients in the drain group, septicemia & pleural effusion were

(7)

the commonest postoperative complication seen 4(8%) each.

 While in the non-drain group of 40 patients 7.50% of patients had developed septicemia.

 In terms of comparison between both the groups had collaborated p value =0.24 which was statistically not significant.

DISCUSSION

Demographic Features

The present study ―Evaluation of importance of drains in elective abdominal surgeries‖ was conducted in the Department of General Surgery at Jawaharlal Nehru Medical College and Acharya Vinoba Bhave Rural Hospital Sawangi (Meghe), Wardha from September 2018 to October 2020.Total 90 Patients were enrolled into this study period after obtaining clearance from the ethical committee and duly obtaining the consent from the patients were studied prospectively.

STUDIES NO. OF PATIENTS (n) MEAN PRESENTATION

Present study 90 45.21±13.88

Imad Wajeh Al-Shahwany et al (2012)(7)

84 27±12YEARS

Chi-Leung Liu et al (2004)(8)

106 53.2 ± 1.4YEARS

Aristithes G Doumouras et al (2017)(9)

142,631 44.7 ±12.0 YEARS

Salamat Khan et al (2015)(10)

171 35.57 ± 16.42 YEARS

Jack Hoffmann Et Al (1986)(11)

70 72 YEARS

 In our study maximum number of patients i.e. 23 were in the age group of 31-40yrs, the mean age of presentation was 45.21±13.88 (11-74 years) with the youngest patient being 11 years old and the oldest patient being 74 years old. Our study data was compared to the following studies as mentioned above.

(8)

STUDIES NO. OF PATIENTS MALE FEMALE

Present study 90 63(70%) 27(30%)

Imad Wajeh Al- Shahwany et al (2012)(7)

84 62(73.8%) 22(26.2%)

Chi-Leung Liu et al (2004)(8)

104 86 (83%) 18 (17%)

William E. Fisher et al (2011)(12)

226 97(43%) 129 (57%)

Salamat Khan et al (2015)(10)

171 116(67%) 55(32.1%)

In our present study, 63(70%) were male patients and 27(30%) were female patients. Data was distributed in a randomized manner giving the M: F ratio of 2.33:1. Our findings were similar to Imad Wajeh Al-Shahwany et al (2012)(7)&Chi-Leung Liu et al (2004)(8) , the males predominance is more as compared to females. However, There was a exception in the case of the study conducted by William E. Fisher et al (2011) (12) where the ratio was 1:1.33 as female patients were in a greater majority as compared to our study.

DISTRIBUTION OF PATIENTS AS DRAIN PLACEMENT/ NON-DRAIN

PLACEMENT

STUDY NUMBER OF

PATIENTS (n)

DRAIN NON-DRAIN

Present study 90 50(55.56%) 40 (44.44%)

Imad Wajeh Al- Shahwany et al (2012)(7)

84 46(54.76%) 38(45.24%)

Zhen Wang (2015)(13)

438 220(51.16%) 218(50.69%)

Chi-Leung Liu (2004)(8)

104 52(50%) 52(50%)

William E. Fisher (2011)(12)

226 179 (79%) 47(21%)

Yao Cheng et al (2016)(14)

711 358(50.3%) 353(49.6%)

Petrowsky et al (2004) (15)

1390 717(51.5%) 673(48%)

(9)

In our present study of 90 patients, 50(55.56%) patients had drain placement while 40(44.44%) patients had no drain placement. Our study was similar to Imad Wajeh Al- Shahwany et al (2012) (7) where the ratio was 54.76% in the drain group and 45.24%

patients in non-drain group &Zhen Wang et al (2015) (13) who had 51.16% patients in drain group & 50.595% patients in non-drain group. Other studies as mentioned in the chart

below have a similar pattern of distribution. However there was a exception in case of the study conducted by William E. Fisher et al (2011) (12) where the ratio was 79 :21 % respectively as mentioned above.

DISTRIBUTION OF PATIENTS ACCORDING TO TYPE OF SURGERY.

In our study patients were divided into 8 groups depending upon the type abdominal surgery they underwent. The data was compared to studies that were carried out on individual type of abdominal surgeries by different authors and their results were analyzed.

 In our present study the majority of patients underwent abdominal wall surgeries 18(20%)

 In our present study 14 (15.56%) underwent colorectal surgeries.

 In our present study Upper gastrointestinal surgeries was carried on 10(11.11%).

 In our present study Appendicular surgeries was carried on 7(7.78%).

 In present study Hepatobiliary surgery was carried out on 12(13.33%).

 In present study Pancreatic surgeries 11 was carried on (12.22%).

 In present study Splenic surgeries was carried on 8(8.89%).

 In present study Urological surgeries was carried on 10(11.11%).

(10)

The data was compared to Studies that were carried on individual types of surgeries and their results were analyzed and incorporated into our study. Imad Wajeh Al-Shahwany et al (2012)(7) carried out his study on appendicular surgeries while William E Fisher (2011)(12)carried out his study focusing on pancreatic surgeries. There were other studies that were carried out as well like Petrowsky et al 2004 (15)& Zheng Wang et al (2015)(13) who focused their studies on Gastrointestinal surgeries. While Guilherme Godoyet et al (2011)(16) focused on urological studies ,Yao cheng et al (2016) did his study in pancreatic surgeries.

Distribution of Drain/Non-Drain patients according to length of hospital stay

 In our present study of, the mean length of hospital stay in the drain group was 22.20±9.61 days with 42%of patients seen in the drain group between 21-30 days.

While in the non- drain group it was 17.22±8.49 days with 35% patients seen in the non-drain group between 11-20days. p=0.10 which is statistically insignificant.

 Non- drain patients in the period of 0-10days contributed around 11(27.50%) with appendicular and abdominal wall surgeries contributing a major portion of it. While colorectal surgeries and pancreatic surgeries contributed towards a longer post- operative recovery.

Length of hospital

stay Drain Non Drain Total χ2-value

0-10 days 4(8%) 11(27.50%) 15(16.67%)

7.60 p=0.10,NS

11-20 days 19(38%) 14(35%) 33(36.67%)

21-30 days 21(42%) 12(30%) 33(36.67%)

31-40 days 4(8%) 3(7.50%) 7(7.78%)

41-50 days 2(4%) 0(0%) 2(2.22%)

Total 50(100%) 40(100%) 90(100%)

Mean±SD 22.20±9.61 17.22±8.49 19.98±9.41

STUDY NUMBER

OF

PATIENTS

LENGTHOF HOSPITAL

STAY IN

DRAIN GROUP

LENGTH OF

HOSPITAL STAY IN NON- DRAIN GROUP

P VALUE

Present study 90 22.20±9.61 days 17.22±8.49 Insignificant

Dr Prashant Raj Pipariya et al 2018(19)

200 8.38 +/- 1.86 days 4.68+/- 1.25 days Insignificant

Imad Wajeh Al- Shahwany et 2012(7)

84 2days+/- 12hours 1day +/- 12hours Insignificant

(11)

Present study 90 22.20±9.61 days 17.22±8.49 Insignificant

 Other studies by Lewis et al 1990 (23) showed that the hospital stay was 5.9+/-2 days in the drainage group while 5.5+/-2 days in the non-drain group. Another similar study carried out by Saad et al1993 (24) showed that the comparison between the drainage group as compared to the non-drain group was not significant.

 In our study, as compared to other studies, most patients remained in the hospital for a longer stay as in all major cases, owing to poor rural setup in our country and lack of access to primary health care workers, patients are willing to stay up to complete treatment until no further medical intervention is required.

Distribution of patients according to post-operative surgical wound site complications.

 In our present study conducted on 50 patients in the drain group, 10(20%) of patients had surgical site infection, while among the 40 non-drain patients only 5(12.50%) of patients had surgical site infection. P-value is 0.34 which is statistically insignificant.

 The results of this study were similar to the studies conducted by Cheng Yet al 2016 (14)&Bawahab et al 2014(21). However there were exceptions from the results differed from our studies conducted by William E. Fisher et al 2011(12)

Cheng Y et al 2015 (20)

711 14.3days 13.8days Insignificant

Bawahab et al 2014(21)

104 4.48+/-2.18 days 2.5+/- 2.2 days Insignificant Adnan Narci et al

2007(22)

226 10.2days 8.3days Insignificant

(12)

Distribution of patients according to post-operative septic complication.

In our present study, septicemia & pleural effusion was the commonest postoperative systemic complication each seen in 4(8%) patients of drain group.

In our present study, septicemia was the commonest postoperative systemic complication seen in 3(7.50%) patients of non-drain group.

Similar to our study, other studies such as Chi-Leung Liu et al (2004)(8) had 3(2%) patients developed pleural effusion in drain group while Jack Hoffmann et al (1986) (11,27)study had 6( 8.5%) & 8 (11%) of drain & Non-drain patients developed respiratory complication28-30. Studies by Jindal et. al. 31 and Fulzele et. al.32 reflected on related issues.

CONCLUSION-

 Routine practice of prophylactic drain placement in abdominal surgeries was associated with higher post-operative morbidity related to both wound & systemic complication. It was also associated with a longer hospital stay.

 So, the concept of prophylactic drainage should be reconsidered.

Funding: This study has not received any external funding.

Conflict of Interest: There are no conflicts of interests.

Informed consent: Written & Oral informed consent was obtained from all individual participants included in the study. Additional informed consent was obtained from all individual participants for whom identifying information is included in this manuscript.

Data and materials availability: All data associated with this study are present in the paper and/or the Supplementary Materials.

STUDIES NO. OF

PATIENTS STUDIED

DRAIN GROUP NON-DRAIN GROUP

Present study 90 4(8%) 3(7.50%)

Chi-Leung Liu et al 2004(8)

104 12(11.5%) 12(11.5%)

William E. Fisher 2011(12)

226 3(2%) 0

Jack Hoffmann Et Al 1986 (11)

70 6(8.5%) 8 (11%)

Dr RN patil et al 2017(25,26)

60 2(3.3%) 0

(13)

Footnotes

Source of support: Nil

Conflict of Interest: None declared.

Ethical approval for human

All procedures performed in this study involving human participants were in accordance with the ethical standards of the

institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable

ethical standards (Institutional Ethics Committee Registration number:

ECR/440/Inst/MH/2013/RR-2016).

Ethical approval

The study was approved by the Medical Ethics Committee of Datta Meghe Institute of Medical Sciences, Deemed University (Ethical approval Ref.No. DMIMS (DU)/IEC/2018- 19/7448).

Data and materials availability

All data associated with this study are present in the paper.

References –

1. Avinash Rinait, Lamture Y.R., P. Prateek, Dilip Gode, A prospective study of aetiology and clinical presentation of gastric adenocarcinoma, Indian Journal of Forensic Medicine

& Toxicology, October-December 2020, 14(4),6241-6245.

2. Robinson JO. Surgical drainage: An historical perspective. Br J Surg. 1986;73(6):422–6.

3. Dr D Rajesh, Dr Y R Lamture. A study on the correlation between endoscopic findings and symptoms of gastro-esophageal reflux disease (GERD). Journal of critical reviews 2019, 6( 6), 860-864 https://dx.doi.org/10.31838/jcr.06.06.145

4. Memon MA, Memon MI, Donohue JH. Abdominal drains: a brief historical review. Vol.

94, Irish medical journal. Ireland; 2001. p. 164–6.

5. Puleo FJ, Mishra N, Hall JF. Use of intra-abdominal drains. Clin Colon Rectal Surg

[Internet]. 2013 Sep;26(3):174–7. Available from:

https://pubmed.ncbi.nlm.nih.gov/24436670

6. Yashwant R. Lamture, Rajesh Domkunti, Avinash Rinait, Mangesh Padmawar.Enterocutaneous fistula in an operated case of total abdominal hysterectomy: a rare case report. Journal of critical reviews 2020, 7(8), 1085-88

DOI: http://dx.doi.org/10.31838/jcr.07.08.227

7. Al-shahwany IW, Hindoosh LN, Rassam R. Drain or Not to Drain in Appendectomy for Perforated Appendicitis. 2012;11(3):349–53.

8. Liu C-L, Fan S-T, Lo C-M, Wong Y, Ng IO-L, Lam C-M, et al. Abdominal drainage after hepatic resection is contraindicated in patients with chronic liver diseases. Ann Surg

[Internet]. 2004 Feb;239(2):194–201. Available from:

(14)

https://pubmed.ncbi.nlm.nih.gov/14745327

9. Doumouras AG, Maeda A, Jackson TD. The role of routine abdominal drainage after bariatric surgery: a metabolic and bariatric surgery accreditation and quality improvement program study. Surg Obes Relat Dis [Internet]. 2017;13(12):1997–2003. Available from:

http://www.sciencedirect.com/science/article/pii/S1550728917303921

10. Khan S, Rai P, Misra G. Is Prophylactic Drainage of Peritoneal Cavity after Gut Surgery Necessary?: A Non-Randomized Comparative Study from a Teaching Hospital. J Clin Diagn Res [Internet]. 2015/10/01. 2015 Oct;9(10):PC01-PC3. Available from:

https://pubmed.ncbi.nlm.nih.gov/26557562

11. Gajbhiye VP, Kale RS, Vilhekar KY, Bahekar SE. Drug utilization study on antimicrobials use in lower respiratory tract infection in Pediatric Intensive Care Unit of Rural Tertiary Care Hospital. J Med Soc 2016; 30:146-8 Available from:

http://www.jmedsoc.org/text.asp?2016/30/3/146/191178

12. Shadma Quazi, Varsha Gajbhiye, Sharjeel Khan, Shailesh Nagpure. Efficacy of Tramadol in Comparision with Diclofenac in Ureteric Colic Patients Brought to a Medical College in Central India- A Prospective Observational Study. Int J Cur Res Rev July 2020, 12 (14) Special Issue ,103-109

DOI: http://dx.doi.org/10.31782/IJCRR.2020.103109

13. Wang Z, Chen J, Su K, Dong Z. Abdominal drainage versus no drainage post- gastrectomy for gastric cancer. Cochrane Database Syst Rev. 2015;2015(5).

14. Cheng Y, Xia J, Lai M, Cheng N, He S. Prophylactic abdominal drainage for pancreatic surgery. Cochrane Database Syst Rev [Internet]. 2016 Oct 21 [cited 2020 Jun 26];(10).

Available from: http://doi.wiley.com/10.1002/14651858.CD010583.pub3

15. Petrowsky H, Demartines N, Rousson V, Clavien P-A. Evidence-based value of prophylactic drainage in gastrointestinal surgery: a systematic review and meta-analyses.

Ann Surg. 2004 Dec;240(6):1074–5.

16. Guilherme G, J. KD, Ari A, E. JJ, Melanie B, Paul R. Routine Drain Placement After Partial Nephrectomy is Not Always Necessary. J Urol [Internet]. 2011 Aug 1;186(2):411–

6. Available from: https://doi.org/10.1016/j.juro.2011.03.151

17. Vecchio R, Intagliata E, Marchese S, Battaglia S, Cacciola RR, Cacciola E. Surgical drain after open or laparoscopic splenectomy: is it needed or contraindicated? G Chir [Internet].

2015;36(3):101–5. Available from: https://pubmed.ncbi.nlm.nih.gov/26188753

18. Cavaliere D, Popivanov G, Cassini D, Cirocchi R, Henry BM, Vettoretto N, et al. Is a drain necessary after anterior resection of the rectum? A systematic review and meta- analysis. Int J Colorectal Dis. 2019 Jun;34(6):973–81.

19. Key A, Sch T, Med JA, Pipariya PR, Darbar R, Gupta A. Scholars Journal of Applied Medical Sciences ( SJAMS ) General Surgery Comparative Study between Drain versus No Drain in Elective Cholecystectomy. 2016;(November):2493–7.

(15)

20. Peng S, Cheng Y, Yang C, Lu J, Wu S, Zhou R, et al. Prophylactic abdominal drainage for pancreatic surgery. Cochrane Database Syst Rev. 2015;2015(8).

21. Bawahab MA, Abd El Maksoud WM, Alsareii SA, Al Amri FS, Ali HF, Nimeri AR, et al. Drainage vs. non-drainage after cholecystectomy for acute cholecystitis: a retrospective study. J Biomed Res [Internet]. 2014/04/10. 2014 May;28(3):240–5.

Available from: https://pubmed.ncbi.nlm.nih.gov/25013408

22. Narcı A, Karaman İ, Karaman A, Erdoğan D, Çavuşoğlu YH, Aslan MK, et al. Is peritoneal drainage necessary in childhood perforated appendicitis?—A comparative study. J Pediatr Surg [Internet]. 2007;42(11):1864–8. Available from:

http://www.sciencedirect.com/science/article/pii/S0022346807004964

23. Lewis RT, Goodall RG, Marien B, Park M, Lloyd-Smith W, Wiegand FM. Simple elective cholecystectomy: To drain or not. Am J Surg [Internet]. 1990;159(2):241–5.

Available from: http://www.sciencedirect.com/science/article/pii/S0002961005802715 24. Saad AM, el Hassan AM, Budd D. Cholecystectomy with and without drainage: a

prospective randomised study. East Afr Med J. 1993 Aug;70(8):499–501.

25. Patil R, Garg M, Shah A, Tomar J, Karad A. Prospective study of use of drains in abdominal surgery in rural area. Indian J Basic Appl Med Res. 2017;(6):622–9.

26. Yashwant R. Lamture, GodeDilip, Dr. Aditya Mundada, A rare case report of isolated tuberculous caecal perforation presented as acute appendicitis. Indian Journal of Forensic Medicine & Toxicology, October-December 2020, 14(4),6233-6236.

27. Priya N, Lamture YR, Luthra L. A comparative study of scalpel versus surgical diathermy skin incisions in clean and clean-contaminated effective abdominal surgeries in AVBRH, Wardha,Maharashtra, India. J Datta Meghe Inst Med Sci Univ 2017;12:21-5.

28. S. Padma, R. Pramila. Pattern of Lower Gastrointestinal Diseases by Colonoscopy and Histopathological Examination: A Retrospective Study International Journal of Current Research and Review. Vol 10 Issue 06, March, 20-25

29. CaglayanGeredeli. Comparison of Somatostatin and Famotidine for the Treatment of Nonvariceal Acute Upper Gastrointestinal Bleeding International Journal of Current Research and Review. Vol 10 Issue 08, April, 25-27

30. Padmwar M, Kakade A. LaproscopicCbd Exploration: Stent Drainage versus TTube Drainage. J. Advanced Research in Health and Allied Science 2020; 1(1): 15-19.

31. Jindal, R., and M. Swarnkar. ―Outcomes Are Local: A Cross Sectional Patient Specific Study of Risk Factors for Surgical Site Infections in Major Abdominal Surgeries.‖

Journal of Krishna Institute of Medical Sciences University 9, no. 1 (2020): 43–50.

32. Fulzele, P., Z. Quazi, A. Sirsam, S. Khobargade, Y. Chitriv, K. Singh, and S. Choudhary.

―Methods for Early Detection of Postoperative Infection: a Review.‖ Journal of Advanced Research in Dynamical and Control Systems 11, no. 8 Special Issue (2019): 3155–67.

Referințe

DOCUMENTE SIMILARE

Taking the MIND-AS-BODY conceptual metaphor as the background of our discussion, we follow Sweetser (1990: 29) and assume that this metaphor is motivated by our tendency

Thus, if Don Quixote is the idealist, Casanova the adventurous seducer, Werther the suicidal hero, Wilhelm Meister the apprentice, Jesus Christ will be, in the audacious and

The number of vacancies for the doctoral field of Medicine, Dental Medicine and Pharmacy for the academic year 2022/2023, financed from the state budget, are distributed to

In terms of sensitivity two studies from the same re- search group comparing US to Magnetic Resonance Imag- ing (MRI) demonstrated that, at shoulder level, US-detect- ed SAD

Medial Tibiofemoral medial joint Longitudinal scan Medial meniscus (Mm) Longitudinal scan Medial collateral ligament (MCL) Longitudinal scan Semimembranosus insertion(Sm)

In this prospective study, we evaluated 30 patients with glossopharyngeal neuralgia clinically who came to department of ENT in Datta Meghe medical college, Nagpur..

The present study ―Evaluation of importance of drains in elective abdominal surgeries‖ was conducted in the Department of General Surgery at Jawaharlal Nehru Medical

CONCLUSIONS- Owing to many factors associated such as drain site infection , hospital psychosispersistent drain site pain , unwillingness among patients for oral diet with drain in