Role of abdominal drains in perforated duodenal ulcer patients: A prospective controlled study

Background: Duodenal ulcer perforation is a common emergency in south India , with about 100-120 cases being treated at Jawaharalal Institute of Post G raduate Medical Education and Research each year. The routine to elate has been to leave two tube drains: one in the Morrison's pouch and one in the p elvis after omental patch closure. This study was conducted to test the eff icacy and safety of drain usage routinely after duodenal ulcer perforation closure with Roscoe Graham omental patch technique. Methods: In this prospective controlled study, 44 patients formed the test group (without drains) and 75 patients formed the control group (with abdom inal drainage). Only patients of perforated duodenal ulcer closed with Rosc oe Graham omental patch technique were included in the study. The incidence of postoperative fever, wound infection, rime for return of bowel function and duration of hospital stay were noted. Details of drainage noted were t he mean amount of daily drainage, mean time of drain removal and occurrence of drain-related complications. Peritoneal fluid, wound discharges, drain tips and drain wounds were cultured. Abdominal ultrasound was performed in all patients in the second postoperative week or if earlier indicated to de tect intra-abdominal collections. Results: It was found that there was no difference in incidence or duration of postoperative pyrexia, return of bowel function or postoperative hospit al stay between the two groups. Routine use of drains was not effective in preventing postoperative fluid collection nor in decreasing the incidence o f intra-abdominal abscesses. The migration of bacteria from the exterior to the peritoneal cavity via the drain was also demonstrated. Drains were fou nd to cause morbidity including intestinal obstruction. Conclusion: The routine use of drains was found to be neither safe nor effe ctive in patients of perforated duodenal ulcer treated by omental patch clo sure.