Bub, David S

Fulmes, Mychailo, MD, PhD

Galler, Avi S

Park, John S

Philp, Matthew M, MD

Sinnott, Robert J

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of SurgeryIs Placement of an Intra-Abdominal DrainNecessary after Hartmann’s Procedure forPerforated Diverticulitis?Mychailo Fulmes MD, PhDLehigh Valley Health Network, Mychailo.Fulmes@lvhn.orgAvi S. GallerLehigh Valley Health Network, Avi_S.Galler@lvhn.orgDavid S. BubLehigh Valley Health Network, David_S.Bub@lvhn.orgRobert J. SinnottLehigh Valley Health Network, Robert_J.Sinnott@lvhn.orgJohn S. ParkLehigh Valley Health Network, John_S.Park@lvhn.orgSee next page for additional authorsFollow this and additional works at: http://scholarlyworks.lvhn.org/surgeryPart of the Other Medical Specialties Commons, and the Surgery CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtFulmes, M., Galler, A. S., Bub, D. S., Sinnott, R. J., Park, J. S., & Philp, M. M. (2012). Is Placement of an Intra-Abdominal DrainNecessary after Hartmann’s Procedure for Perforated Diverticulitis?. LVHN Scholarly Works. Retrieved fromhttp://scholarlyworks.lvhn.org/surgery/16AuthorsMychailo Fulmes MD, PhD; Avi S. Galler; David S. Bub; Robert J. Sinnott; John S. Park; and Matthew M.Philp MDThis poster is available at LVHN Scholarly Works: http://scholarlyworks.lvhn.org/surgery/16Lehigh Valley Health Network, Allentown, PAIs Placement of an Intra-Abdominal Drain Necessary after Hartmann’s Procedure for Perforated Diverticulitis? Background:M.Fulmes, A.S.Galler, D.S.Bub, R.J.Sinnott, J.S.Park, M.M.Philp, Colorectal Surgery Department•		Placement	of	intraperitoneal	or	pelvic	drain	after	colon	and	rectal	resection	is	addressed	in	term	of	affecting	the	anastomotic	healing1.•		Hartmann’s	procedure	(HP)	for	perforated	diverticulitis	is	the	standard	of	care	in	most	instances.	Intra-abdominal	drain	placement	at	the	time	of	initial	surgery	is	common,	though	no	benefit	has	been	proven.	To	date,	there	are	no	studies	evaluating	the	routine	use	of	pelvic	drainage	after	HP.	The	purpose	of	this	study	was	to	examine	the	rate	of	postoperative	abscess	formation	depending	on	the	presence	or	absence	of	intra-abdominal	drainage.References:1	 	Bozzetti	F.	Drainage	and	other	risk	factors	for	leakage	after	anterior	resection	in	rectal	cancer	patients.	Ann	Surg.	2005	Dec;242(6):902;	author	reply	902-3.	No	abstract	available.Methods:•		A	retrospective	chart	review	was	performed	on	all	patients	undergoing	HP	for	perforated	diverticulitis	between	November	2006	and	June	2010	at	the	Lehigh	Valley	Health	Network.		The	decision	for	placement	of	a	closed	suction	drain	at	the	time	of	initial	surgery	was	at	the	discretion	of	the	operating	surgeon.		Postoperative	intra-abdominal	abscess	was	diagnosed	by	computed	tomography	(CT)	in	those	cases	where	there	was	a	clinical	suspicion.		The	incidence	of	postoperative	abscess	was	compared	in	those	patients	with	a	drain	versus	those	without	a	drain.Conclusions:•		The	incidence	of	postoperative	intra-abdominal	abscess	after	Hartmann’s	procedure	for	perforated	diverticulitis	was	not	affected	by	placement	of	an	intra-abdominal	drain.		The	incidence	of	abscess	was	actually	higher	in	our	group	of	patients	with	a	drain,	though	it	was	not	statistically	significant.	Routine	placement	of	a	drain	is	not	necessary	after	Hartmann’s	procedure	and	may	in	fact	be	detrimental.	Results:•		A	total	of	113	patients	underwent	HP	during	the	study	period.	Forty-five	patients	had	an	intra-abdominal	drain	placed	at	the	time	of	initial	surgery,	while	68	patients	did	not.		There	was	no	difference	between	the	two	groups	with	regard	to	age,	sex,	BMI,		Hinchey	classification	and	other	co-morbidities	(see	Table	1).	•		The	overall	incidence	of	intra-abdominal	abscess	in	our	study	group	was	7.96%	(9/113).		In	the	drainage	group,	11.1%	(5/45)	of	patients	developed	an	abscess	compared	to	5.8%	(4/68)	in	the	undrained	group	(see	Table	2)	.		While	the	incidence	of	abscess	was	higher	in	the	drainage	group,	the	difference	was	not	statistically	significant	(p=0.478). Table 1. Some characteristics and risk factors for             abscess formation comparing two groups Group with Drain(n=45)Group without Drain(n=68) p-valueAge	(mean) 61 56 0.057BMI	(mean) 30.4 30.0 0.807Steroid	Use 7	(15.6%) 11	(16.2%) 0.871COPD 2	(4.4%) 4	(5.9%) 0.917DM 12	(26.7%) 10	(14.7%) 0.182Blood	Transfusion 6	(13.3%) 4	(5.9%) 0.298ASA	IY 7	(15.6%) 9	(13.2%) 0.934Hichey	Class	IY 3	(6.67%) 8	(11.8%) 0.917 Table 2. Frequency of postoperative abscess              formation  Patients with Drain(n=45)Patients without Drain(n=68) p-valuePostoperative	Abscess 5	(11.1%) 4	(5.8%) 0.505No	Abscess 40 64 	

Is Placement of an Intra-Abdominal Drain Necessary after Hartmann’s Procedure for Perforated Diverticulitis?

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Is Placement of an Intra-Abdominal Drain Necessary after Hartmann’s Procedure for Perforated Diverticulitis?

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