Prevention of incisional surgical site infection by subfascial closed suction drainage after open laparotomy: a single surgeon experience in 250 consecutive patients

Abstract

Background: Open laparotomy with gastroenterological surgery is a surgical procedure results in a relatively high rate (about 10% or more) of incisional surgical site infection (SSI). To reduce incisional SSI after open laparotomy, mechanical preventors, such as subcutaneous wound drainage or negative-pressure wound therapy (NPWT), have been tried; however, conclusive results have not been obtained. This study evaluated the prevention of incisional SSI by first subfascial closed suction drainage after open laparotomy.

Methods: A total of 453 consecutive patients who underwent open laparotomy with gastroenterological surgery by one surgeon in one hospital (between August 1, 2011, and August 31, 2022) was investigated. Same absorbable threads and ring drapes were used in this period. Subfascial drainage was used in consecutive 250 patients in the later period (between January 1, 2016, and August 31, 2022). The incidences of SSIs in the subfascial drainage group were compared to those of in the no subfascial drainage group.

Results: (a) No incisional SSI (superficial and deep) occurred in the subfascial drainage group (superficial = 0% [0/250] and deep = 0% [0/250]). As a result, incidences of incisional SSI of the subfascial drainage group were significantly lower than those of the no subfascial drainage group (superficial = 8.9% [18/203]; deep = 3.4% [7/203]) (p < 0.001 and p = 0.003, respectively). (b) Four out of seven deep incisional SSI patients in the no subfascial drainage group underwent debridement and re-suture under lumbar or general anesthesia. (c) There was no significant difference in the incidences of organ/space SSI of the two groups (3.4% [7/203] in the no subfascial drainage group and 5.2% [13/250] in the subfascial drainage group) (P = 0.491).

Conclusion: Subfascial drainage was associated with no incisional SSI after open laparotomy with gastroenterological surgery.

Keywords: Gastroenterological surgery; Incisional surgical site infection; Laparotomy; Subfascial closed suction drainage; Surgical site infection.

Fig. 1

7F conventional drain tube with discontinuous small holes (tkb SurgicalProducts, TOKIBO)® and a low-pressure (30–80 mmHg), continuous-aspiration portable reservoir (Bulb-type 100 ml)

Fig. 2

Schema of closure of abdominal wall and placement of subfascial drain tube

Fig. 3

Subfascial drainage along the full length of the subfascial incision. Exit of the drain was placed separate from the incision at the caudal site, and connected to a low-pressure (30–80 mmHg), continuous-aspiration portable reservoir (Bulb-type 100 ml)