بررسي اثر درناژ بسته در پيشگيري از عوارض زخم هرنيوپلاستي اينگوينال با استفاده از پروتز: گزارش كوتاه

Closed suction drainage using Lichtenstein technique in preventing wound complications following inguinal hernioplasty: brief report

زمينه و هدف: يكی از روش‌های شايع درمان فتق اينگوينال ترميم با پروتز به روش Lichtenstein می‌باشد. برای جلوگيری از توليد و يا تخليه سريع سروما، برخی جراحان موافق تعبيه درن مكشی بسته و برخی ديگر با آن موافق نيستند. روش بررسی: در يك مطالعه كارآزمايی بالينی، 42 بيمار كانديد ترميم فتق اينگوينال به روش Lichtenstein در بيمارستان اميرالمومنين (ع) سمنان از بهمن 1389 تا اسفند 1390، به‌طور تصادفی به دو گروه با و بدون استفاده از درن ساكشن بسته تقسيم شدند. بيماران 24 ساعت، 7-4 روز و 15-10 روز پس از عمل از نظر تشكيل سروما، هماتوم و عفونت زخم ويزيت شدند. يافته‌ها: 24 ساعت و نيز 7-4 روز پس از عمل، سروما، هماتوما و عفونت زخم در هيچ يك از دو گروه مشاهده نشد. تنها 15-10 روز پس از عمل يك مورد عفونت زخم در گروه با درن مشاهده گرديد (99/0=P). نتيجه‌گيری: برای جلوگيری از ايجاد عوارض درن، مصرف بی‌رويه آنتی‌بيوتيك، افزايش مدت بستری ، بهتر است در اين نوع جراحی از درن استفاده نشود.

Background: Inguinal hernia is a common surgical problem which increases with aging especially in men. A common method for treatment is surgical repair using prosthesis, Lichtenstein technique. One frequent complication after inguinal herniorrhaphy is soft tissues seroma. There are several methods to prevent or to drain seroma. Some surgeons suggest the insertion of closed suction drainage system but others disagree. Methods: In this clinical trial study, 42 patients who are candidate for hernia repairing (Lichtenstein technique), referred to Amir Al-Momenin Hospital in Semnan, Iran, from 2011 to 2012, were randomly divided into two groups. So that, the list of eligible patients in the study, were numbered, and then using the patientsʹ code, patients, who assigned an odd number in the registration list, were allocated to group 1, the remainder were placed in group two. The two first numbers in registration list (1 or 2), were randomly assigned to groups. Group 1 underwent hernia surgery without closed suction drainage and the second group underwent hernia surgery with closed suction drainage. The patients were evaluated for seroma, hematoma or wound infection after 24 hours, during days 4 to 7 and days 10 to 15 following surgery. Results: No adverse event including hematoma, seroma or wound infection occurred in either group with or without closed suction drainage in the first 10 days after surgery. Only one patient carried wound infection during days 10 to 15 following operation who was in the group with closed drainage (P=1.00). Conclusion: In this study, Seroma and hematoma was not observed in patients with and without closed suction drainage. To avoid drainsʹ complications, indiscriminate use of antibiotics, prolonged hospital stay, we do not recommend the use of drains in this type of surgery.