Efficacy of Subcutaneous Negative Pressure Suction Drainage in Preventing Superficial Surgical Site Infections Following Laparotomy: A Randomised Controlled Trial

INTRODUCTION

Surgical site infections (SSIs) are a leading cause of morbidity following open abdominal procedures, particularly in emergency or contaminated cases. Incidence rates for SSIs range from 5% to 40%, depending on wound classification, comorbidities, and operative technique.^[1,2] They not only increase hospitalisation and healthcare costs but may also necessitate re-operations and cause poor postoperative outcomes.^[3]

A known modifiable risk factor for SSIs is dead space in subcutaneous tissues, which permits fluid collection and subsequent bacterial colonisation. Various strategies have been employed to address this, including delayed skin closure, prophylactic antibiotics, and the use of subcutaneous drainage.^[4,5]

Subcutaneous negative pressure suction drains, such as the Romovac or Jackson-Pratt, may help reduce SSIs by continuously evacuating exudate and minimising tissue oedema.^[6] This trial evaluates their efficacy in patients undergoing elective or emergency laparotomy.

MATERIAL AND METHODS

RESULTS

DISCUSSION

This study confirms the utility of subcutaneous negative pressure suction drainage in reducing superficial SSI rates. The drain group experienced nearly 50% fewer infections compared to the no-drain group, aligning with findings by Fujii et al.,^[1] Watanabe et al.,^[6] and Arer et al.^[4]

The mechanism is straightforward: negative pressure drains remove serous fluid and blood from the subcutaneous space, preventing bacterial proliferation and tissue maceration. Ishinuki T et al.^[2] and Baier et al.^[3] noted similar benefits in hepatobiliary and general abdominal surgeries.

While some trials have suggested limited benefit in clean wounds,^[7] the current study demonstrates clear utility in clean-contaminated and contaminated laparotomy cases. The findings are also consistent with Centres for Disease Control (CDC) guidelines on SSI prevention in high-risk abdominal surgeries.^[8]

A meta-analysis by Petrosillo et al. showed that 38.6% of SSIs occur post-discharge, suggesting the need for continued outpatient follow-up.^[9] In our study, all patients were followed until drain removal and discharge, but longer-term surveillance may further capture late-onset SSIs.

Limitations include single-centre design, small sample size, and lack of long-term follow-up. Future multicenter studies with larger populations could help refine drain removal timing, which varies in the literature from 3 to 7 days.^[6,10]

CONCLUSION

Subcutaneous negative pressure suction drainage is an effective, low-risk intervention that significantly reduces superficial SSI incidence following laparotomy. It should be considered, especially in emergency surgeries and for patients with thick subcutaneous fat or higher contamination risk.