TMSS Medical College Journal

Background: Surgical site infections are most common in case of acute & complicated appendectomy. In some cases, percentage of infections is very high. By taking a simple measure we can reduce the infection rate very easily. Objective: The aim of our study was to find out whether insertion of a sub cutaneous antiseptic wick drain can reduce the SSIs in acute and complicated appendectomy. Materials & Methods: A hospital based randomized control study was performed in the department of surgery 250 Bedded Sadar Hospital, Jashore. Patients who has definitive acute & complicated appendicitis and undergone appendectomy were included. A total of 60 patients were included among them 30 patients in study group and 30 patients in control group. In study group the wound wick was soaked in 10% povidone iodine and placed in the wound, one end of wick was kept outside the caudal part of wound. Wicks were inspected daily. On 4" post-operative day wick was removed. All the patients received antibiotics prophylaxis. They were reviewed while in hospital and after 4 weeks following operation in outdoor basis for evidence of any wound infection. Results: Overall infection of study group was 03(10%) patients and control group was 22(73%) patients. The main outcome measures were wound infection, wound discomfort and cosmetic result. The P value of the result is <0.001 which is statistically significant. Conclusion: We concluded that the use of wound wick drain was associated with decreased wound infection rates following appendectomy. So, this simple measure is therefore appropriate in view of its greater convenience and safety.

Surgical site infections (SSIs) are defined as wound infection following invasive surgical procedure. Surgery for complicated appendicitis is associated with highest rate of infective complications specially (SSIs). In this type of operation wound infection rate is 9 to 53 %'. SSIs lead to increased morbidity alongside increasing unnecessary patients suffering and decreased quality of life’. Recently, so many studies show that average hospital stay is (15-18) days in patients who developed SSIs after complicated appendectomy. If post appendectomy SSIs does not develop then average hospital stay only (3-5) days. Longer hospital stay decrease quality of life of patient as well as huge cost for the patient and also for the country. Several risk factors for developing SSIs have been identified. Such as current smoking, BMI, obesity, depth of subcutaneous fat, nutritional status, diabetes mellitus, sudden co-morbidities, ASA class and operation time but single most risk factor is complicated appendicitis. ~~ Complications are gangrenous appendicitis and perforated appendicitis. Various interventions have been proposed to reduce SSIs’. A number of them are used to routine practice. Hand washing, minimizing shaving, skin preparation and pre-operative antibiotics have all gained acceptance in the surgical community but use of antiseptic wick drain is a new concept to reduce SSIs. It has been found that hematoma, serous fluid and dead space in surgical incisional wound increases the risk of infection as these acts as a culture medium. Subcutaneous drain soaked with antiseptic solution reduces the risk of infection®. However, the use of post-operative subcutaneous wound drainage is not universally accepted. In addition, drains may not efficacious and cause discomfort’. The aim of our study is use of antiseptic wick drain to reduce appendectomy wound infection.