Wissenschaftliche Artikel Archive

The association of surgical drains with surgical site infections – A prospective observational study.

Mujagic E, Zeindler J, Coslovsky M, Hoffmann H, Soysal SD, Mechera R, von Strauss M, Delko T, Saxer F, Glaab R1, Kraus R, Mueller A, Curti G, Gurke L, Jakob M, Marti WR, Weber WP.

Abstract
BACKGROUND:

Surgical drains are widely used despite limited evidence in their favor. This study describes the associations between drains and surgical site infections (SSI).
METHODS:

This prospective observational double center study was performed in Switzerland between February 2013 and August 2015.
RESULTS:

The odds of SSI in the presence of drains were increased in general (OR 2.41, 95%CI 1.32-4.30, p = 0.004), but less in vascular and not in orthopedic trauma surgery. In addition to the surgical division, the association between drains and SSI depended significantly on the duration of surgery (p = 0.01) and wound class (p = 0.034). Furthermore, the duration of drainage (OR 1.24, 95%CI 1.15-1.35, p < 0.001), the number (OR 1.74, 95%CI 1.09-2.74, p = 0.019) and type of drains (open versus closed: OR 3.68, 95%CI 1.88, 6.89, p < 0.001) as well as their location (overall p = 0.002) were significantly associated with SSI.
CONCLUSIONS:

The general use of drains is discouraged. However, drains may be beneficial in specific surgical procedures.

Clinical Outcome After Rectal Replacement With Side-to-End, Colon-J-Pouch, or Straight Colorectal Anastomosis Following Total Mesorectal Excision: A Swiss Prospective, Randomized, Multicenter Trial (SAKK 40/04)

Marti WR, Curti G, Wehrli H, Grieder F, Graf M, Gloor B, Zuber M, Demartines N, Fasolini F, Lerf B, Kettelhack C, Andrieu C, Bigler M, Hayoz S, Ribi K, Hamel C; Swiss Group for Clinical Cancer Research (SAKK), Section Surgery.

Abstract

OBJECTIVE:

To compare, in a phase 3, prospective, randomized, multi-center clinical trial functional outcome of reconstruction procedures following total mesorectal excision (TME).
SUMMARY BACKGROUND DATA:

Intestinal continuity reconstruction following TME is accompanied by postoperative defecation dysfunctions known as „anterior resection syndrome.“ Commonly used reconstruction techniques are straight colorectal anastomosis (SCA), colon J -pouch (CJP), and side-to-end anastomosis (SEA). Comparison of their functional outcomes in prospective, randomized, multi-center studies, including long-term assessments, is lacking.

METHODS:

Patients requiring TME for histologically proven rectal tumor, with or without neoadjuvant treatment, age ≥ 18 years, normal sphincter function without history of incontinence, any pretreatment staging or adenoma, expected R0-resection, were randomized for standardized SCA, CJP, or SEA procedures. Primary endpoint was comparison of composite evacuation scores 12 months after TME. Comparison of composite evacuation and incontinence scores at 6, 18 and 24 months after surgery, morbidity, and overall survival represented secondary endpoints. Analysis was based on „per protocol“ (PP) population, fully complying with trial requirements, and intention-to treat (ITT) population.

RESULTS:

Three hundred thirty-six patients from 15 hospitals were randomized. PP population included 257 patients (JCP = 63; SEA = 95; SCA = 99). Composite evacuation scores of PP and ITT populations did not show statistically significant differences among the 3 groups at any time point. Similarly, composite incontinence scores for PP and ITT populations showed no statistically significant difference among the 3 trial arms at any time point.

CONCLUSIONS:

Within boundaries of investigated procedures, surgeons in charge may continue to perform reconstruction of intestinal continuity following TME at their technical preference.