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Article
Post-appendectomy Infected Wounds and Ideal Management A Retrospective Study

Author: Mahmoud M. Al-Mukhtar محمود محمد المختار
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2014 Volume: 10 Issue: 17 Pages: 118-124
Publisher: Al-Qadisiyah University جامعة القادسية

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Background :Abdominal operations are traditionally classified into elective and emergency procedures both of which may be complicated by postoperative wound infections. Although postoperative wound infection is usually infrequent following elective procedures, it is an anticipated and acceptable complication of emergency surgeries as these operations are usually of a contaminated nature with no standard preoperative preparation associated with an urge to operate.Objectives :This study tries to compare the results of a two adopted regimes to manage post-appendectomy wound infections in regard to the significance of using parenteral antibiotics.Methods : This study had evaluated (108) patients with clinical postoperatively wound infections over a period of (3) years in Al-Hilla General Teaching Hospital. All cases with normal appendices and those on preoperative antibiotics therapy for any reason had been excluded from the study. Two treatment regimes had been evaluated : Regime (A) consisting of changing antiseptic wound dressings only while Regime (B) consisted of changing antiseptic wound dressings combined with parenteral administration of intravenous metronidazole (500) mg thrice daily with intravenous cefotaxime (1000) mg twice daily. The study group had been allocated to a randomized single-blind trial to assess the outcomes. Patients were followed–up to an average of (50) days.Results :There is a beneficial effects of adopting Regime (B) in the management of infected wounds following perforated appendectomies in terms of reducing the number of dressings change and the period of inpatients hospitalization . This was not the case with infected wounds following non-perforated appendectomies.Conclusion : According to the literature reviewed, in order to prevent or reduce the rate of post-appendectomy infected wounds it is recommended to use preoperative prophylactic antibiotics which is not a routine in our practice.Wound irrigation with antiseptics may be beneficial in prevention of wound infection following complicated appendectomy. Regime (B) of treatment should be reserved for infected wounds following complicated appendectomy.

خلفية البحث : تصنف العمليات الجراحية البطنية تقليديا الى عمليات أختيارية و أخرى طارئة و كلاهمها من الممكن أن يتبع بعدوى جروح العمليات . وفيما تعتبر عدوى الجروح في العمليات الأختيارية من غير الشائعة فأنها من المضاعفات المتوقعة و المقبولةفي جراحة الطواري كونها عادة ما تكون ملوثة و تجرى بدون تحضير قياسي لما قبل العملية مع وجود دافع للتداخل الجراحيالسريع .الأهداف : تهدف هذه الدراسة الى مقارنة نتائج أستخدام نظامين لعلاج عدوى جروح أستئصال الزائدة و تقييم الفائدة المرجوة من أستخدام المضادات الحياتية حقنا بالوريد .الطريقة : قيمت هذه الدراسة (108) مصابا بعدوى جروح أستئصال الزائدة على مدى ثلاث سنوات في مستشفى الحلة التعليمي العام . تم أستثناء كل الحالات التي كانت فيها الزائدة غير ملتهبة أو كان المريض يتعاطى المضادات الحياتية ما قبل العملية لأي سبب كان . كان النظام العلاجي ( أ ) مكونا من تبديل ضماد الجروح بضمادات مطهرة و حسب الحالة بينما كان النظام العلاجي ( ب )مكونا من تبديل ضماد الجروح بضمادات مطهرة و حسب الحالة مع أضافة المضاد الحياتي المترونيدازول (500 ) ملغم وريديا ثلاث مرات يوميا مع السيفوتاكسيم (1000) ملغم وريديا مرتين يوميا . تم توزيع المرضى بصورة عشوائية في تجربة مفردة التعمية على النظاميين العلاجيين ( أ ) و ( ب ) لغرض تقييم النتائج. تم متابعة المرضى لمدة معدلها (50) يوما .النتائج : كانت هناك نتائج مفيدة بأستخدام النظام العلاجي (ب) في علاج عدوى جروح عمليات أستئصال الزائدة المثقوبة و ذلك بدلالة تناقص في عدد الضمادات المستخدمة وفي فترة رقود أقل في المستشفى . لم تكن النتائج كذلك عند معالجة عدوى جروح عمليات أستئصال الزائدة غير المثقوبة .الأستناج :أستنادا الى مراجعة الدراسات و التقارير السابقة التي تناولت نفس الموضوع فأنه من المستحسن أستخدام علاج المضاد الحياتي الأحترازي قبل أجراء العملية و لكن هذا لا يتم العمل به في ممارستنا الجراحية . أن غسل الجروح بالمطهرات بعد أستئصال الزائدة المثقوبة مباشرة مفيد لمنع حدوث عدوى الجروح . يوصى بأن النظام العلاجي (ب ) يجب أن يستخدم لعلاج عدوى جروح أستئصال الزائدة المثقوبة تحديدا.


Article
Interval Appendectomy: Surgical and Pathological Basis

Author: Safa M. Al-Obaidi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2007 Volume: 6 Issue: 3 Pages: 184-189
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

SUMMARY:BACKGROUND:The treatment of appendiceal mass is controversial. For patients initially treated conservatively with antibiotics with or with out drainage, the role of interval appendectomy is an area of considerable debate.AIM :To evaluate the indications of interval appendectomy in patients presented with appendicular mass in correlation with post operative histopathological results.PATIENTS & METHODS:This is a prospective study of 97 cases with the diagnosis of appendicular mass admitted and treated conservatively in Baghdad Teaching Hospital during the period from December 2002 to December 2006 then scheduled for interval appendectomy. .Histopathology of the appendix examined and correlation of the result with certain clinical characteristic of the patients .RESULTS :The prevalent age group was 30-39 years (39%) and male to female ratio was 2.8:1. Postoperative histopathological features of the excised specimens showed that 85/97 (88%) of patients had chronically fibrosed appendix with obliterated lumen. The remaining 12/97 ( 12%) of patients were having inflamed appendices. There was a clear correlation the age of patient above 40 years (41%)and initial clinical response (94%) with the histopathologic support for appendectomy .CONCLUSION:Interval appendectomy was mandatory in the following groups of patients:Patients ≥ 40 years old.Patients with poor initial response to conservative treatment.Patients with recurrent symptoms.Patients with WBC count ≥ 12000 cell/cc.


Article
EARLY APPENDECTOMY DURING PREGNANCY
استئصال الزائده الدوديه المبكر عند الحوامل

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ABSTRACTBackground: Appendectomy for presumed acute appendicitis is the most common surgical emergency during pregnancy, acute appendicitis occurs at the same rate in pregnant and non pregnant women, but pregnant women have a higher rate of perforation. Patients &methods: This prospective study done 42 pregnant women between age 20 to 41 years all of them were complained from signs and symptoms of acute appendicitis arrived ER of Al Hussain teaching hospital in AL Nassyria during period 2010 either came directly or referred from gynecologist ,they underwent appendectomy early after diagnosis .Results: Most of patients succeeded pregnancy 38 patients (90.4%) { in spite of 3 patient (7%) have threatened abortion anther 3 patients have preterm uterine contraction but they continue of pregnancy successively},only 4 patient (9.5%) end with abortion.Most of women [21patients (50%)] complained from acute appendicitis during second trimester .Most of patients who did not delay operation till 48 hours can pass pregnancy successfly with some problems , while who delayed more liable to abortion [4 of 10 patient (40%)] . Aim: reduce fetal loss after appendectomy during pregnancy. Conclusion: we advices early operation in pregnancy with out delay, no place for conservative management in acute appendicitis .

ألخلاصه دراسه مستقبليه أجريت على 42 من النساء الحوامل بفترات متباينة من الحمل تتراوح اعمارهن بين 20 الى 42 عاما دخلن طوارئ مستشفى الحسين التعليمي في الناصريه خلال عام 2010 جميعهن أصبن بالتهاب الزائده الدوديه إثناء حملهن ( الكثير منهن مرسلات من قبل طبيبات نسائيه) وقد تم تشخيصها سريريا مع مساعده بعض الفحوصات المتوفره ثم أجرينا عمليه استئصال الزائده الدودبه بعد وصولهن الطوارئ بفترة وجيزة فكانت النتائج كالاتي :- 1- كان معظم النساء 38 أمراءه( 4،90 %) قد أكملن حملهن بسلام بالرغم من 3 نساء(7%) أصبن بإجهاض مهدد و 3 أخريات (7%) بألم قوي بسبب تقلصات رحميه مبكرة) لكنهن أكملن حملهن بسلام فقط أربعه مريضات (6،9 %) انتهى حملهن بالإجهاض 2-أكثر حالات الزائدة الدودية تحدث خلال الأشهر الثلاثة الوسطى21 مريضه 50% 3- وجد نا المريضات اللواتي يتأخرن بأجراء العملية ل 72 ساعة او أكثر هن اكثر عرضه للاجهاض من غيرهن ( 4 مريضات من اصل 10 ) او من مشاكل الحمل الأخرى مثل الإجهاض المهدد او التقلصات ألرحميهلذا ننصح بأجراء عمليه الزائدة الدودية اثتاء الحمل بعد تشخيصها سريريا وبعض الفحوصات المتوفرة بأقرب وقت ممكن لتفادي تلك المشاكل


Article
Meta- Analysis to find out an ideal treatment for Acute appendicitis

Author: Hadi Awad Hmoud
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2015 Volume: 8 Issue: 1 Pages: 2098-2105
Publisher: Kerbala University جامعة كربلاء

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Abstract

background: Open appendectomy (OA) was the standard procedure for inflamed appendix. First laparoscopic appendectomy (LA) was done in 1980 since then Laparoscopic Appendectomy has been gaining more popularity and approval despite the controversies that surrounding its safety and universal applicability.Aim: This is a comparative study to evaluate the safety, effectiveness and the superiority of LA vs OA in treating the acute appendicitis.Materials and methods: This retrospective study was performed by examining huge number of literatures and huge number of clinical observations regarding treatment of acute appendicitis after applying new parameters like patient selection, operating time, hospital stay, cost effectiveness, intra and postoperative complications, needs for painkillers, role of antibiotics, operative technique and cosmetic issues.Result: Large number of studies have showed that LA is highly beneficial for young age group females, it shortens the hospital stay time, minimizes the need for post- operative painkillers, and it bears good cosmetic outcome. On the other hand it carries serious complications, it is time consuming technique, and it impacts big financial burden. While antibiotics use and modifying the type of operative techniques can improve the overall outcome for both modalities.Discussion: This study has found that both laparoscopic and open appendectomy have some advantages and disadvantages, but logical evaluation of these outcomes clearly shows that, the LA impacts more serious and devastating complication, which may outweigh its benefits.Conclusion: By careful reviewing of all above parameters we can reach an important decision regarding the ideal approach for operating on acute appendicitis, such decision gives the superiority for the OA over the LA in treating acute appendicitis, especially in an attempt to avoid devastating complications.


Article
Histopathological effects of Appendectomy on rabbit liver
التأثير النسجي لأستئصال الزائدة الدودية على كبد الارانب

Author: Shurooq Hameed Majeed Al-nassiri شروق حميد مجيد الناصري
Journal: Tikrit Journal of Pure Science مجلة تكريت للعلوم الصرفة ISSN: 18131662 Year: 2017 Volume: 22 Issue: 1 Pages: 36-40
Publisher: Tikrit University جامعة تكريت

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Inorder to detect the effect of excision the appendex on histological structure of rabbit Liver. This study was done in the field of poultry at the department of Animal resource / college of Agriculture / university of Tikrit for the period from 10/1/2014 until 1/6/2014, and the results showed significant changes in the histological structure consisted changes were the shape and size of Liver cells and appearance of focal agregation of lymphocytes distributed among hepatic cells in portal areas and around central veins as well as fibrosis the Liver and infiltration of white boold cells, including phagocytic cells in the interstitial tissue with the emergence of an increase in the thickness of the epithelium of gall bladder ducts and presence many of Kupffer cells in the sinusoids.

بغية الكشف عن تأثير رفع الزائدة الدودية على التركيب النسجي لكبد الارانب، تمت هذه الدراسة في حقل الدواجن التابع لقسم الثروة الحيوانية في كلية الزراعة/ جامعة تكريت وللفترة من 10/1/2014 ولغاية 1/6/2014 ، وبينت النتائج حدوث تغيرات كبيرة في التركيب النسجي لمتن الكبد تمثلت بتغيير شكل وحجم الخلايا الكبدية وظهور تجمعات بؤرية من الخلايا اللمفية موزعة بين خلايا الكبد وفي الباحات البابية وحول الاوردة المركزية فضلا" عن تليف أجزاء من الكبد وهناك أرتشاح كريات الدم البيض من ضمنها الخلايا البلعمية في النسيج الخلالي مع ظهور زيادة في سمك ظهارة القنوات الصفراوية ووجود خلايا كوفر في الجيبانيات الدموية بكثرة.الكلمات الدالة: الزائدة الدودية، الكبد، أزالة الزائدة الدودية، الانسجة المرضية

Keywords

Appendix --- Liver --- Appendectomy --- Histopathology


Article
Laparoscopic versus open appendectomy in patients with acuteappendicitis

Author: Tariq Al-Aubaidi طارق العبيدي
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2011 Volume: 7 Issue: 2 Pages: 78-84
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Laparoscopic surgery for appendicitis is now a well established and advanced method of performing general surgical procedures. Objectives: To compare the outcome of laparoscopic and open appendectomies in terms of operative time, analgesic requirement, postoperative complications, hospital stay, return to normal activity and condition of scar. Methods: This prospective study was carried out from 1stMay 2008-1st January 2010, involving 110 patients (45 male and 65 female) with features suggestive of acute appendicitis were divided into 45 patients laparoscopic appendectomy (LA) group and 65 patients open appendectomy (OA) group, after taking informed consent. LA was done with the help of three trocars/cannulae creating pneumoperitoneum with CO2 whereas OA was performed by grid iron incision. Results: Forty five patients were assigned to the laparoscopic appendectomy group and 65 patients were assigned to the open appendectomy group. Five patients were converted intra-operatively from laparoscopic appendectomies to open procedures. The operating times in OA and LA were 20-110 minutes (mean 30) and 45-120 minutes (mean 55) respectively. Increased doses of analgesics, antibiotics and antiemetics were required in OA, as compared to LA. The mean postoperative hospital stay in LA group was 1 day (range 1-3 days) where as it was; 2.2 days (range 2-5 days) in OA group. Conclusion: LA is safe and it has major benefits like less postoperative pain, decreased wound infection, early hospital discharge, early return to work and a better cosmetic scar than OA.


Article
ANATOMICAL VARIATION OF THE APPENDIX IN RELATION WITH APPENDECTOMY DECISION

Author: Taqi S Atiyah تقي سعدون
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2012 Volume: 10 Issue: 1 Pages: 60-68
Publisher: Al-Nahrain University جامعة النهرين

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BackgroundThe signs and symptoms of acute appendicitis vary according to the site of the appendix; and absence of tenderness in the right iliac fossa dose not exclude appendicitis like in postileal, subhepatic and pelvic appendix. Even Alvarado scale zero is not excluding the diagnosis of acute appendicitis.ObjectiveTo study the incidence of delayed appendectomy and its relation to the anatomical variation of the appendix and its morbidity.MethodsA prospective study for patients whom underwent appendectomy for acute appendicitis during the period from-June 2009 to June-2010. The appendix of all the patients was submitted to histopathological examination and was proved to be acutely inflamed. The patients were divided into two groups according to the time interval from the onset of the first symptom to the time of appendectomy. In group A, this interval was more than 72 hours; while in group B it was less than 72 hours.ResultsGroup A includes 35 patients; while group B include 201 patients. The anatomical site of the appendix in group A was very significant in delayed decision of appendectomy in postileal appendix (P=0.0001), subhepatic appendix (P=0.0004), and significant in retrocecal appendix (P=0.017); but it is not significant in pelvic appendix (P=0.88), paracecal appendix (P=0.83) and preileal appendix (P=0.95). Patients in group A had longer hospital stay due to complications 35 (100%) generalized peritonitis and 3 (8.57%) patients were died due to septic shock which is significant (P=


Article
Review of Histopathological Diagnoses of One Year Appendectomy Specimens in Sulaimani City
مراجعة نسجية مرضية لعينات الزائدة الدودية المستأصلة في سنة واحدة في مدينة السليمانية

Authors: Ali Ibrahim --- Hassanain H. Khudier --- Hadeel A. Yasseen
Journal: nursing national Iraqi specility المجلة العراقية الوطنية للعلوم التمريضية ISSN: 18122388 Year: 2013 Volume: 26 Issue: 2 Pages: 102-115
Publisher: Baghdad University جامعة بغداد

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Abstract: Objective: To review and see the pattern of histopathological diagnoses of one year appendectomy specimens. Methodology: This retrospective study was carried in Sulaimani Teaching Hospital over the period of one year (from 1st of January to 31st of December 2009). All pathological reports were reviewed retrospectively for patient’s age, sex, histopathological diagnosis and operative findings (if present). Histopathological diagnoses then were classified into either positive or negative for acute inflammation. Any associated findings or any surgical specimen removed with the appendix was recorded. The obtained data were analyzed by using the statistical package social sciences (SPSS) version 19; with Chi square to test for significance between data. Results: Hospital pathological reports of 2052 appendectomy cases were reviewed, (47.12%) were males and (52.88%) were females. 61.9% of all appendectomy cases were positive for acute inflammation (32.9% had acute appendicitis; 26.1 % had acute suppurative appendicitis , and 4.5% had gangrenous appendicitis), while 38.1% were negative (28.5 % had reactive follicular hyperplasia, 6.2% were normal, and 0.2% had carcinoid tumors). Negative for acute inflammation cases were generally significantly more common in females e.g. periappendicitis, RFH and carcinoid tumor but eosinophilic appendicitis cases like acute appendicitis were more common in males. Normal appendixes versus RFH (without associated appendicitis) are two entities that intermingle. Chronic appendicitis is controversial entity. Out of 20 cases with Entrobius vermicularis (95%) cases were associated with reactive follicular hyperplasia and it shows non significant association with acute appendicitis.Recommendation: We recommend that the pathologists must be strict to histological criteria for each pathological entity before the diagnosis.

المستخلص:الهدف: تهدف الدراسة الحالية لمراجعة تشخيصات الزرع النسجي لكافة حالات استأصال الزائدة الدودية لمدة عام كامل.المنهجية: هذه الدراسة اجريت في المستشفى التعليمي في السليمانية ولمدة سنه كاملة ابتداءأ من الأول من كانون الثاني ولغاية الحادي والثلاثين من كانون الأول لعام 2009. وفيها تم مراجعة كافة تقارير الزرع النسجي لحالات استأصال الزائدة الدودية لكلا الجنسين ولكافة الأعمار وتسجيل كل الملاحضات الطبية العمليات المرافقة للأستأصال (ان وجدت). تم تصنيف التشخيصات الى موجبة وسالبة نسبة لوجود أو عدم وجود الألتهابات الحادة. وكذلك تم تسجيل الأيجادات والمستأصلات الجراحية المرافقة.وتم تحليل البيانات من خلال تطبيق البرنامج الأحصائي لتحليل المعلومات. لتحليلchi square وباستعمال SPSS version 19 النتائج: تم مراجعة 2052 تقرير زرعي نسجي, وكانت نسبة الذكور47.12% والباقي (52.88%) اناث.وقد كان 61.9 % من المجموع الكلي للحالات موجبة نسبة لوجود الأتهابات الحادة وكالأتي: 32.9% التهاب الزائدة الدودية الحاد, 26.1% التهاب الزائدة القيحي و 4.5% الغانغارينا. بينما كان 38.1% من المجموع الكلي للحالات سالب نسبة لوجود الألتهابات وكما يلي: 28.5% من العينات مشخصة كتضخم العقيدات اللمفاوية لجدار الزائدة الدودية , 6.2%طبيعية و0.2% تحوي ورم الكارسينويد. وقد كانت الحالات السالبة للألتهاب الحاد أكثر حدوثا في الأناث مثل التهاب ماحول الزائدة , تضخم العقيدات اللمفاوية والورم الكارسينويد أما الألتهاب المزمن للزائدة الدودية فهو مثار للنقاش. من مجموع 20 حالة استأصال للزائدة الدودية تحتوي على الدودة الدبوسية وجد ان 95% سببت تضخم العقيدات اللمفاوية ولم توجد علاقة بين وجود الديدان الدبوسية والتهاب الزائدة الحاد.التوصيات: أوصي اطباء الزرع النسجي بالتقيد بالصفات المجهرية في تشخيص كل مجموعة مرضية.


Article
LAPAROSCOPIC VERSUS OPEN APPENDECTOMY FOR ACUTE APPENDICITIS

Author: Mansour Ameen Mohammed
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 Year: 2015 Volume: 21 Issue: 1 Pages: 76-81
Publisher: Basrah University جامعة البصرة

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Abstract

Acute appendicitis is still considered the most common cause of acute abdomen in young adult age group. Appendectomy is the most frequent urgent abdominal operation and often is the 1st major procedure performed by surgeons in training. This study aimed to find whether laparoscopic appendectomy is superior to open approach or not. This study was done in Al-Mawanee General Hospital in Basrah, Iraq. One hundred and sixty seven patients were randomized into open appendectomy group (OA) and laparoscopic appendectomy group (LA). Different parameters were studied to find which approach is the best. The study showed longer operative time in the LA group, while there was no significant difference regarding the hospital stay, post-operative pain and post-operative complication. In conclusion, laparoscopic appendectomy is not found to be superior to open appendectomy as there was no clear significant difference between them regarding the parameters used in this study.


Article
Drain or Not to Drain in Appendectomy for Perforated Appendicitis

Authors: Imad Wajeh Al-Shahwany --- Laith Naief Hindoosh --- Raid Rassam --- Abbas Al-Qadhi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2012 Volume: 11 Issue: 3 Pages: 349-352
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Acute appendicitis is the most common surgical cause of acute abdomen necessating surgical intervention. Prophylactic drainage is commonly used in surgical practice, as in acute perforated appendicitis.OBJECTIVE:To evaluate the advantages & disadvantages of the prophylactic drainage after appendectomy for acute perforated appendicitis.METHODS:Eighty four patients of acute perforated appendicitis were enrolled in this prospective comparative study done in Al-Kindy Teaching Hospital from October 2009 to March 2011. They were divided into two groups; 46 patients (54.76%) drainage group & 38 patients (46.24%) non-drainage group. Hospital stay time & postoperative wound infection were assessed in both groups. Statistical analysis using Minitab software version 14 to calculate the P value was done.RESULTS:Patients’ age ranged from 6-50 years (mean27±12), male:female ratio was 2.6:1. The incidence of perforation in acute appendicitis was 15.9% irrelevant to age or sex. Mean hospital stay time was 36 hours in the non-drainage group & mean of 58±4 in the drained group. Wound infection was 39.13% in the drainage group & 36.84% in the non-drainage group, with a P value was >0.05.CONCLUSION:postoperative wound infection & hospital stay were less in the non-drainage group for this prophylactic drainage should be reconsidered

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