Generalist versus Abdominal Subspecialist Radiologist Interpretations of Abdominopelvic Computed Tomography Performed on Patients with Abdominal Pain and its Impact on the Therapeutic Approach.

INTRODUCTION: Abdominal pain is one of the most common patient complaints in the emergency department (ED) and abdominopelvic computed tomography (ACT) scan plays an important role in evaluation of these patients. OBJECTIVE: The aim of this study was to determine the differences between interpretations by generalist radiologists and abdominal subspecialist radiologists regarding the abdominopelvic computed tomography (ACT) of patients who were admitted to the Emergency Department (ED) and to investigate its effect on the patients' therapeutic approach. METHODS: The records of 16452 patients who were admitted to the emergency department with complaint of abdominal pain between January 2015 and April 2017 were reviewed, retrospectively. Out of these patients, 245 (1.5%) underwent ACT for differential diagnosis and among them, 137 (0.8%) patients had their ACT reports evaluated by generalist radiologists in 45 minutes and by abdominal subspecialist radiologist 8-12 hours later and were included in the study. Patients were divided into three groups according to the effect of ACT reports on the performed treatment. Group 1: no effect on planned treatment, group 2: minor effect on planned treatment, which did not result in a change in the treatment process and group 3: major effect on planned treatment approach, which resulted in a change in the treatment process. These changes included at least one of the two criteria: changing the indication of surgery from emergency surgery to elective surgery and/or discharge of the patient from the ED, when actually hospitalization was required. RESULTS: Out of the 137 patients, 87 (63.5%) were male, 50 (36.5%) were female and the patients' mean age was 56 (27-93) years. There were 117 (85.4%) patients in group 1, 15 (10.9%) patients in group 2, and 5 (3.7%) patients in group 3. We determined minor inconsistency between the reports in group 2 and major inconsistency in group 3. Patients in group 3 suffered from delayed surgical intervention due to inconsistency of the CT reports resulting in prolonged hospital stay and increased morbidity. In 17 patients (four patients in Group 1 and 13 patients in Group 2) treatment plan was changed due to CT results; and while surgical treatment was planned for them prior to CT scan, they were discharged with medical treatment after that and overtreatment was prevented. CONCLUSION: Contribution of abdominal radiologists to evaluation of ACT images in the ED would reduce the inconsistency in ACT reports and prevent the patients from receiving insufficient treatment or overtreatment.

Outcomes of Total Parathyroidectomy with Autotransplantation versus Subtotal Parathyroidectomy Techniques for Secondary Hyperparathyroidism in Chronic Renal Failure.

OBJECTIVE: To compare the safety and the effectiveness of total parathyroidectomy with autotransplantation versus subtotal parathyroidectomy for refractory secondary hyperparathyroidism in patients with chronic kidney disease. STUDY DESIGN: A comparative study. PLACE AND DURATION OF STUDY: Baskent University, Adana Medical and Research Center, Adana, Turkey, from January 2012 to November 2018. METHODOLOGY: Patients operated upon for refractory secondary hyperparathyroidism by the general surgery team were inducted. Overall, 25 (40%) patients underwent total parathyroidectomy with autotransplantation (Group 1), whereas 37 (60%) patients underwent subtotal parathyroidectomy (Group 2). Patient files were retrospectively analysed for recurrence or persistence of hyperparathyroidism. RESULTS: A total of 62 patients, 32 (52%) of whom were females, with a mean age of 41.4 ±15.8 years for group 1; and 30 patients were males with a mean age of 43.1 ±16.7 years for group 2 were assessed in this study. The presenting complaints were bone pains and malaise supported by laboratory values that showed consistently elevated parathyroid hormone levels (>200 pg/ml). In the postoperative follow-up, 29 patients (46.8%) had transient hypocalcemia, while 3 (5%) had persistent hypoparathyroidism. In Group 1, one (4%) patient had a recurrence, while 4 (16%) patients had persistent hyperparathyroidism. In contrast, two (5.6%) patients in Group 2 had recurrence, whereas 8 (22%) patients had persistent hyperparathyroidism. CONCLUSION: Both surgical options can be safely utilised in the management of refarctory secondary hyperparathyroidism. Moreover, regardless of the procedure used, all the parathyroid glands must be explored. However, due to high morbidity and failure rates of subsequent surgeries, the surgeon should be keen and thorough in the initial procedure.

Hand-made Extracorporeal Knotting versus Hem-o-Lok Clip for Stump Closure in Laparoscopic Appendectomy.

OBJECTIVE: To compare hand-made extracorporeal knotting and hem-o-lok clip for the closure of appendix stump regarding safety, complications and cost-effectiveness. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Baskent University Adana Teaching and Research Center, between January 2010 and December 2016. METHODOLOGY: A total of 287 patients, who underwent laparoscopic appendectomy, were enrolled in this study. Patients were divided into hand-made extracorporeal knotting and hem-o-lok clip groups. Patients were compared according to age, gender, duration of symptoms, serum leukocyte count, American Society of Anesthesiologists (ASA) score, intraoperative findings, operation time, hospital stay, pathology report and complications. RESULTS: Of 287 patients, 149 (51.9%) were female and 138 (48.1%) were male. The mean age was found 34.9 years. No statistical difference was observed between groups according to age, gender, duration of symptoms, serum leukocyte count, ASA score, operation time and hospital stay. Intraoperative findings were different between groups (p<0.05). Overall postoperative complication rate was 6.6%. No statistical difference was observed regarding complications Conclusion: Both hand-made extracorporeal knotting and hem-o-lok clips can be used for stump closure in laparoscopic appendectomy. Hand-made extracorporeal knotting is an effective, safe and costeffective method alternative to hem-o-lok clips.

Acute Respiratory Failure in Renal Transplant Recipients: A Single Center Experience.

OBJECTIVES: We evaluated the frequency and cause of acute respiratory failure in renal transplant recipients. MATERIALS AND METHODS: Our single-center retrospective observational study included consecutive renal transplant recipients who were admitted to an intensive care unit for acute respiratory failure between 2011 and 2017. Acute respiratory failure was defined as oxygen saturation < 92% or partial pressure of oxygen in arterial blood < 60 mm Hg on room air and/or requirement of noninvasive or invasive mechanical ventilation. RESULTS: Of 187 renal transplant recipients, 35 (18.71%) required intensive care unit admission; 11 of these patients (31.4%) were admitted to the intensive care unit with acute respiratory failure. Six of these patients (54.5%) had pneumonia and had shown infiltrates on chest radiography, which were shown in a minimum of 3 zones of the lung (2 with Klebsiella pneumonia, 1 with Acinetobacter species, 1 with Proteus mirabilis, 2 with no microorganisms). The other reasons for acute respiratory failure were cardiogenic pulmonary edema (2 patients), acute respiratory distress syndrome (2 patients, due to acute pancreatitis and acute cerebrovascular thromboembolism), and exacerbation of chronic obstructive pulmonary disease (1 patient). Six patients (54.5%) needed invasive mechanical ventilation because of pneumonia (3 patients), cardiogenic pulmonary edema (2 patients), and cerebrovascular thromboembolism (1 patient). Hemodialysis was administered in 5 patients (45%). Six of 11 patients died due to pneumonia (3 p atients), cardiogenic pulmonary edema (2 patients), and cerebrovascular thromboembolism (1 patient). Among the 5 survivors, 3 (60%) had recovered previous graft function. CONCLUSIONS: Acute respiratory failure is associated with high mortality and morbidity in renal transplant recipients. Main causes of acute respiratory failure were bacterial pneumonia and cardiogenic pulmonary edema in our study population. Extended chemoprophylaxis for bacterial and fungal infection and early intensive care unit admission of patients with acute respiratory failure may improve outcomes.

Comparison of the Early-Term Complications and Patency Rates of the Standard (Parachute) and Diamond-Shaped End-To-Side Anastomosis Techniques in Arteriovenous Fistulas Created for Hemodialysis.

OBJECTIVE: To compare the early-term patency and complication rates of the end-to-side anastomosis techniques parachute and diamond-shaped techniques in arteriovenous fistulas. STUDY DESIGN: Prospective randomised study. PLACE AND DURATION OF STUDY: Department of General Surgery, Adana Baskent University Application and Research Hospital, Adana, Turkey, between October 2014 and January 2015. METHODOLOGY: Patients with end stage renal disease who underwent arteriovenous fistula creation for hemodialysis were grouped into two according to the anastomosis technique performed. Group 1 was composed of the patients undergoing the standard parachute technique and Group 2 consisted of the patients operated with the diamond-shaped anastomosis technique. The two groups were compared with each other with respect to clinical and demographic data, operative and postoperative variables, and complication and patency rates. RESULTS: A total of 56 patients underwent arteriovenous fistula creation. The overall complication rate was 12.5%. The early-term patency rate was higher in the diamond-shaped anastomosis technique than the standard parachute end- to-side anastomosis technique. Effective dialysis was established after 4 weeks in 48 (85.7%) patients in the overall study group, 23 (82.1%) in Group 1, and 25 (89.2%) in Group 2. However, there was no significant difference between both the techniques with respect to effectiveness of dialysis. CONCLUSION: Both end-to-side anastomosis techniques have their own advantages and disadvantages. Using a patient- specific suitable technique rather than a standard technique would be more appropriate in arteriovenous fistulas formation.

Assessment of Atrial Fibrillation and Ventricular Arrhythmia Risk After Transplant in Patients With End-Stage Renal Disease by P-wave/QT Interval Dispersion, T-Wave Peak-End Interval, and T-Wave Peak-End/QT Interval Ratio.

OBJECTIVES: The association between end-stage renal disease with atrial fibrillation and ventricular arrhythmias is well documented. The aim of this study was to investigate whether kidney transplant has any effect on P-wave dispersion, a predictor of atrial fibrillation and corrected QT interval dispersion, T-wave peak-end interval, and T-wave peak-end/corrected QT ratio, which are predictors of ventricular arrhythmias in patients with end-stage renal disease. MATERIALS AND METHODS: In a retrospective study, 234 patients (125 kidney transplant and 109 healthy control patients) were examined. P-wave dispersion, corrected QT dispersion, T-wave peak-end interval, and T-wave peak-end/corrected QT ratio values before and 3, 6, and 12 months after transplant were calculated and compared in transplant recipients. Baseline values of the control group were compared with 12-month values of kidney transplant patients. RESULTS: We observed a statistically significant decline in P-wave dispersion, corrected QT dispersion, T-wave peak-end interval, and T-wave peak-end/corrected QT ratio values among the pretransplant and 3-, 6-, and 12-month posttransplant measurements (P < .001 for all comparisons). However, the values of these measurements in the transplant group at 12 months were significantly higher than baseline values of the control group (P < .001 for all comparisons). CONCLUSIONS: P-wave dispersion, corrected QT dispersion, T-wave peak-end interval, and T-wave peak-end/corrected QT ratio were shown to be attenuated after transplant, although they remained higher than baseline measurements in healthy individuals. These results indirectly offer that there may be a reduction in risk of atrial fibrillation and ventricular arrhythmias after transplant.

Retrospective Analysis of Patients with Synchronous Primary Breast and Thyroid Carcinoma.

OBJECTIVE: Breast and thyroid cancers are commonly encountered malignancies. Increased risk of breast cancer in follow-up period of thyroid cancer or vice versa has been reported. However, they have some associations, synchronous presentation of these tumors is rare. We presented 12 patients diagnosed as breast and thyroid cancer and treated at the same time. MATERIALS AND METHODS: Mastectomy and thyroidectomy were performed in 19 patients at the same time. 7 patients were excluded because of benign thyroid pathology. Therefore 12 patients who had diagnosis of synchronous breast and thyroid cancer were included. Data regarding clinical, pathological, treatment and prognostic factors was retrospectively analyzed. RESULTS: Total thyroidectomy was performed in all patients. The mean age of patients was 54 years (min. 44-max. 70). Only one patient was male. Thyroid pathology was detected preoperatively by FDG PET-CT scan in 11 patients. Breast reconstruction was performed in three patients. The most commonly seen thyroid malignancy was papillary thyroid carcinoma. Postoperative complication rate was 33.3%. Adjuvant chemotherapy was given in 11 patients whereas one patient received adjuvant radiotherapy. CONCLUSION: Although synchronous presentation of breast and thyroid cancer is rare, surgical treatment of both of these tumors can be safely performed at the same time. Association of these tumors should be evaluated by large scaled studies.

Assessment of Atrial Fibrillation and Ventricular Arrhythmia Risk after Bariatric Surgery by P Wave/QT Interval Dispersion.

BACKGROUND: The association of obesity with atrial fibrillation (AF) and with ventricular arrhythmias is well documented. OBJECTIVE: The aim of this study was to investigate whether weight reduction by a laparoscopic sleeve gastrectomy has any effect on P wave dispersion (PWD), a predictor of AF, and corrected QT interval dispersion (CQTD), a marker of ventricular arrhythmias, in obese individuals. METHODS: In a prospective study, a total of 114 patients (79 females, 35 males) who underwent laparoscopic sleeve gastrectomy were examined. The patients were followed 1 year. PWD and CQTD values before and 3rd, 6th, and 12th months after the surgery were calculated and compared. RESULTS: There was a statistically significant decline in body mass index (BMI), PWD, and CQTD values among baseline, 3rd, 6th, and 12th months (p < 0.001 for all comparisons). Correlation analysis showed a statistically significant correlation between ΔPWD and ΔBMI (r = 0.719, p < 0.001), ΔPWD and Δleft ventricular end-diastolic diameter (LVEDD) (r = 0.291, p = 0.002), ΔPWD and Δleft atrial diameter (LAD) (r = 0.65, p < 0.001), ΔCQTD and ΔBMI (r = 0.266, p = 0.004), ΔCQTD and ΔLVEDD (r = 0.35, p < 0.001), ΔCQTD and ΔLAD (r = 0.289, p = 0.002). In multiple linear regression analysis, there was a statistically significant relationship between ΔPWD and ΔBMI (ß = 0.713, p < 0.001), ΔPWD and ΔLVEDD (ß = 0.174, p = 0.016), ΔPWD and ΔLAD (ß = 0.619, p < 0.001), ΔCQTD and ΔBMI (ß = 0.247, p = 0.011), ΔCQTD and ΔLVEDD (ß = 0.304, p < 0.001), ΔCQTD and ΔLAD (ß = 0.235, p = 0.009). CONCLUSION: PWD and CQTD values of patients were shown to be attenuated after bariatric surgery. These results indirectly offer that there may be a reduction in risk of AF, ventricular arrhythmia, and sudden cardiac death after obesity surgery.

Incidence and risk factors of biliary fistulation from a hepatic hydatid cyst in clinically asymptomatic patients.

Biliary fistulation from a hepatic hydatid cyst is its most frequent complication. If unrecognised, this may cause difficulties during and after surgical intervention. Our study looked into its incidence and also the possible risk factors in a retrospective investigation of 60 patients (34 women) who had undergone surgery or percutaneous treatment. Demographics and anatomical characteristics, such as cyst type, location, number, diameter and laboratory findings were examined. A full 50% had biliary fistulation, with increased risk if the cyst diameter was ≥8.8 cm.

Is there a correlation between the severity of Idiopathic Granulomatous Mastitis and pre-treatment Shear-Wave Elastography Findings? Original research.

AIM: The aim of this study was to analyze the correlation between the severity of idiopathic Garulomatous Mastitis (IGM) and the pre-treatment Shear-Wave Elastography (SWE) findings. MATERIAL AND METHODS: A total of 39 patients diagnosed with granulomatous mastitis were included in the study between the dates of December 2014 and February 2017. The patients were divided into two groups. Group 1 was treated using a conservative protocol and steroids. Group 2 was treated surgically. Pre-treatment SWE findings of both groups were compared. RESULTS: The mean ages of the patients in group 1 and 2 were 38.44±9.6 and 36.05±7.44 years, respectively. There were not any significant differences between the groups with regard to frequency of BI-RADS categories and Virtual touch tissue imaging (VTI) patterns. The mean Shear-Wave Spead (SWS) were 1.98 ± 1.02 m/sec and 2.82± 1.66 m/sec in group 1 and 2 respectively. The difference was not significant (p ≥ 0.05). The BI-RADS categories and VTI patterns did not show significant difference when the recurrent and non-recurrent patients were compared. CONCLUSION: There may not be a correlation with the pre-treatment SWE findings and severity of the IGM. KEY WORDS: Breast, Elasticity Imaging Techniques, Granulomatous mastitis, Ultrasonography.

Total Versus Subtotal Gastrectomy for Signet Ring Cell Carcinoma of the Stomach.

OBJECTIVE: To determine the adequate surgery type for the treatment of signet ring cell of stomach in terms of postoperative complications and survival. STUDY DESIGN: Comparative analytical study. PLACE AND DURATION OF STUDY: Baskent University Adana Teaching and Research Center, Adana, Turkey, between 2006 and 2015. METHODOLOGY: Atotal of 46 patients with the diagnosis of gastric signet ring cell, who underwent total or subtotal gastrectomy, were enrolled in this study. Patients were compared according to age, gender, tumor location, TNM stage, survival and mortality rates, operation time, complication and recurrence. Comparisons between groups were performed by using Mann-Whitney U-test for the data not normally distributed. The categorical data were analyzed by using the Chisquare test or Fisher's exact test, where applicable. Kaplan-Meier test was used for survival curve and Long-rank test was used for survival differences between groups. Values of p < 0.05 were considered statistically for all tests. RESULTS: Of the 46 patients, 29 (63.0%) were male. The mean age was 56.6 ±13.2 years. The median tumor size was 5.0 cm (IQR: 3.0-6.6). Twenty-six (56.5%) patients were in total gastrectomy, whereas 20 (43.5%) were in subtotal gastrectomy group. Five-year cumulative survival rate was 0.487. Five-year overall survival rate for early and advanced signet ring cell carcinoma was 0.830 and 0.164, respectively (p<0.001). Five-year overall survival rate for total and subtotal gastrectomy groups were 0.422 and 0.582, respectively (P=0.417). Complications were observed in 17.4% (n=8) of all 46 patients. CONCLUSION: Subtotal gastrectomy can be performed safely for patients with gastric signet ring cell carcinoma and is equal to total gastrectomy with respect to prognosis and complication rates.

Long-term results of retromuscular hernia repair: a single center experience.

INTRODUCTION: Incisional hernia (IH) is one of the most frequent postoperative complications after abdominal surgery. There are multiple surgical techniques described for IH repair. The aim of the study is to evaluate the effect of primary fascial closure on long-term results in retromuscular hernia repair (RHR) for incisional hernias. METHODS: A total of 132 patients underwent RHR for IH were included in our study. 109 patients were evaluated in 2009 and 55 patients in 2015 for short and long-term results. RESULTS: Among 132 patients perfromed RHR, fascia was closed in 107 (81%) and left open in 25 (19%) patients. The mean age of patients was 57.9 ± 11.8 years. Average mesh area was 439.8 ± 194.6 cm2, hernia area was 112 ± 77.5 cm2 and open area after repair was 40.8 ± 43.3 cm2. Mean follow-up of 104 patients regarding postoperative complications evaluated in 2009 was 30.7 ± 14.1 months. Recurrent IH was observed in 6 (4.5%) patients according to data collected in 2009. Long-term results were; mean follow-up period was 91 ± 20.2 months (20-112 months) and recurrent IH was observed in 4 (7.3%) patients. CONCLUSION: Retromuscular repair for incisional hernia regardless of the fascial closure gives high patient satisfaction, less recurrence rates and complications in long-term follow-up.

Can red cell distribution width be used as a predictor of acute cholecystitis?

OBJECTIVE: Acute cholecystitis is a common disease requiring accurate markers for diagnosis and proper treatment. The aim of this study was to investigate the role of red cell distribution width (RDW) in acute cholecystitis. MATERIAL AND METHODS: 299 were included in the study. The subjects were divided into 2 groups; group 1 (n: 46) acute cholecystitis group and group 2 (n: 253) chronic cholecystitis group. The patients were compared with respect to demographic characteristics, white blood cell count, C-reactive protein, and red cell distribution width. RESULTS: A statistically significant difference was observed between groups with respect to gender, white blood cell count, C-reactive protein, and red cell distribution width level (p<0.05). The mean red cell distribution width level of group 1 and 2 was 14.19±2.02% and 15.03±2.51%, respectively. CONCLUSION: Red cell distribution width level can be used as a predictor of acute cholecystitis. Multicenter prospective studies should be performed to elucidate the exact role of RDW level in acute cholecystitis.

Primary small intestinal non-Hodgkin lymphoma diagnosed after emergency surgery.

BACKGROUND: The aim of this study was to investigate clinical manifestation, diagnosis, treatment, and prognosis of patients with primary gastrointestinal non-Hodgkin lymphoma (PGI NHL), whose initial presentation was bowel obstruction or perforation. METHODS: Data of patients who underwent surgical intervention due to radiological evidence of perforation or intestinal obstruction and were subsequently diagnosed with intestinal lymphoma at Baskent University hospitals between January 2007 and November 2014 were examined retrospectively. Medical records, clinical history, symptoms, pathological reports, and treatment modalities were analyzed. RESULTS: Study population comprised 17 patients (8 male, 9 female) with PGI NHL and mean age of 52±20.2 years. Symptoms reported by the patients were abdominal pain, nausea, vomiting, weight loss, and loss of appetite. All 17 patients underwent surgical treatment; 12 also received postoperative chemotherapy. Most common pathological subtype was diffuse large B-cell lymphoma (70.5%). Mean follow-up time was 26 months (range: 1-69 months) and 5-year survival rate was 64.3%. CONCLUSION: Initial presentation of PGI NHL may be obstruction with or without perforation; clinicians and surgeons should keep this in mind while assessing patient with bowel obstruction, and particularly patient in fifth decade of life.

Prophylactic oral calcium supplementation therapy to prevent early post thyroidectomy hypocalcemia and evaluation of postoperative parathyroid hormone levels to detect hypocalcemia: A prospective randomized study.

BACKGROUND: Postoperative hypocalcemia is the most common complication after total thyroidectomy. Postoperative parathyroid hormone (PTH) measurement is one of the methods to detect or prevent postoperative hypocalcemia. Prophylactic oral calcium supplementation is another method to prevent early postoperative hypocalcemia. The aim of this study is to detect the accurate timing of PTH and evaluate efficacy of routine oral calcium supplementation for postoperative hypocalcemia. METHODS: A total of 106 patients were performed total thyroidectomy. Rotuine oral calcium supplementation was given to group 1 and no treatment to group 2 according to randomization. Serum calcium and PTH level of patients in group 2 at postoperative 6, 12 and 24 h and patients in both groups at postoperative day 7 were evaluated. Patients were compared according to age, sex, operation findings, serum calcium and PTH levels and symptomatic hypocalcemia. RESULTS: Half of the patients (50%) were in group 1. Most of the patients were female (83%). The most common etiology of thyroid disease was multinodular goiter (64.1%). Oral calcium supplementation was given to 18 (33.9%) patients in group 2. Symptomatic hypocalcemia for group 1 and 2 was found to be 1.9 and 33.9% respectively (p < 0.05). No statistical difference can be observed regarding the timing of serum biomarkers. CONCLUSION: Serum PTH levels at postoperative 12 and 24 h can predict early post-thyroidectomy hypocalcemia. Prophylactic oral calcium supplementation therapy can prevent early post-thyroidectomy hypocalcemia with advantages of being cost effective and safe.

Unusual location of median raphe cyst presenting as perianal polyp: a case report.

Median raphe cysts (MRC) are uncommon, benign congenital lesions that may present anywhere in the midline between the urinary meatus and the anus, with the shaft of the penis and the glans penis being the most common sites. We report a 52-year-old man with median raphe cyst unusually located in perianal region and treated by surgical excision.

Rupture of an Aneurysm of a Small Branch of the Superior Mesenteric Artery: A Case Report.

BACKGROUND: Superior mesenteric artery aneurysm (SMAA) is an uncommon vascular disorder. Complications such as rupture have been reported. Once complication has been encountered both surgical and endovascular treatment techniques can be considered. CASE REPORT: We present a case of 68-year old male patient with SMAA rupture treated by endovascular modality. CONCLUSIONS: Endovascular therapy is an effective and less invasive option for rupture of superior mesenteric artery aneurysm.

Anastomotic Leakage in a Patient with Acute Intestinal Obstruction Secondary to Appendiceal and Ileal Endometriosis: A Case Report.

Endometriosis is a commonly encountered problem in women of reproductive age. It usually causes chronic abdominal pain. However, it rarely causes complications such as intestinal obstruction. The most commonly performed procedure for these patients is bowel resection and anastomosis. Unless it is complicated with anastomotic leakage. We present a 39-year-old woman presented with intestinal obstruction due to appendiceal and ileal endometriosis complicated with anastomotic leakage after surgery.

The effect of subcutaneous suction drains on surgical site infection in open abdominal surgery A prospective randomized study.

AIM: Surgical site infection (SSI) is a major problem associated with open abdominal surgery and related to increased morbidity and mortality rates, healthcare costs and also incisional hernia. A negative pressure subcutaneous drain reduces dead space in subcutaneous tissue by preventing accumulation of fluid. The aim of current study was to establish the efficacy of a subcutaneous drainage system for preventing SSI after open abdominal clean-contaminated surgery. MATERIAL AND METHODS: A total of 62 patients underwent abdominal surgery, between November 2014 and March 2015, were enrolled. 48 eligible patients, were randomized into subcutaneous drainage (DG) and no drainage group (NDG). Antibiotic prophylaxis was appiled to each patient. The diagnosis of superficial SSI was made according to the Centers for Disease Control and Prevention's (CDC) definition. RESULTS: The mean age of patients was 48.77 ± 12.62 years with a male-female ratio of 21:27. No statistical difference between groups was observed for age, sex, comorbidity, incision type, hemoglobin level, blood loss, hospital stay and operation time (P>0.05). 2 (8.7%) patients in DG and 8 (32%) patients in NDG had incisional SSI but no statistical difference was observed (P>0.05). CONCLUSION: SSI appear to be reduced with subcutaneous suction drains in open abdominal surgery however prospective randomized larger scaled studies should be performed on this topic. KEY WORDS: Abdominal surgery, Subcutaneous drain, Surgical site infection.