Evaluating The Outcomes Of Primary Skin Closure And Abdominal Drain Insertion In Emergency Hysterectomy Secondary To Post Cesarean Section Endomyometritis At Kamuzu Central Hospital

Evaluating The Outcomes Of Primary Skin Closure And Abdominal Drain Insertion In Emergency Hysterectomy Secondary To Post Cesarean Section Endomyometritis At Kamuzu Central Hospital

Melina Kang’oma, Mike Kamkwanya , Carol Dzorani
Kamuzu Central Hospital, Lilongwe, Malawi; kamuzu Central Hospital, LILONGWE, Malawi

ABSTRACT

BACKGROUND
Endomyometritis is the most severe form of puerperal sepsis and one of the major leading causes of Maternal Mortality in Malawi. The mainstay treatment is an emergency total abdominal hysterectomy with or without primary skin closure and abdominal drain insertion. Surgical incisions in endomyometritis are contaminated but primary closure is still the preferred technique which increases the risk of wound breakdown. Abdominal drains are placed to prevent reaccumulation of infected peritoneal fluid and avert need for surgical re-exploration. This study evaluated the outcomes of primary skin closure and abdominal drain insertion in emergency hysterectomy for post-caesarean endomyometritis.

METHODS
A retrospective quantitative study conducted at Kamuzu Central Hospital analysing 59 case files of emergency hysterectomy secondary to endomyometritis from January to June 2024. Secondary data was collected using an electronic database Kobo Collect. The data was analysed using descriptive statistics and inferential statistics with Fishers exact test.

RESULTS
The average age of women who underwent hysterectomy was 22 years. 85% had primary skin closure and 69 % had abdominal drains inserted. 72% of primary skin closures developed surgical site infection on average after 4 days. 19 % required in surgical re-exploration. Drain insertion had significant association with surgical re-exploration and mortality (p= 0.012 and p =0.023) respectively. Both skin closure and drain insertion had no effect on length of hospital stay and the average length of hospital stay was 21 days. The total mortality was 16.39%.

CONCLUSION
Primary skin closure in postpartum emergency hysterectomy due to endomyometritis increased the rate of surgical site infection and abdominal drains did not reduce the rate of surgical re-exploration. The findings of the study question the traditional paradigm of primary skin closure and drain insertion benefits. Further studies with controlled variables are needed to establish optimum management standards for postpartum endomyometritis.

Keywords: Endomyometritis, Total abdominal hysterectomy, Primary skin closure, Surgical site infection