Catheter Drainage Group Research Articles

Laparoscopic cholecystectomy versus percutaneous catheter drainage for acute cholecystitis in high risk patients

Aim: To assess which treatment modality, Patients with AC who are at a high risk should have a cholecystectomy performed using or percutaneous catheter drainage. Methodology: Sixty people were included in this study because they got diagnosed with acute calculous cholecystitis. Both the procedure of laparoscopic cholecystectomy and percutaneous catheter drainage were offered to them at random. Results: In terms of the need for further surgery, there was a statistically significant difference between the groups as there were 2 (6.7%) who needed re-intervention in laparoscopic cholecystectomy group and 14 (46.7%) in percutaneous catheter drainage group (p=0.001*), recurrent biliary disease as there were 2 (6.7%) in laparoscopic cholecystectomy group and 17 (56.7%) in percutaneous catheter drainage group (p<0.001*) and total length of hospital stay as the mean of laparoscopic cholecystectomy group was 4.9 (±2.77 SD) while in percutaneous catheter drainage group was 10.67 (±6.62 SD).Conclusion: Cholecystectomy with laparoscopic is favored over percutaneous drainage for high-risk individuals with acute cholecystitis. When compared to percutaneous catheter drainage, laparoscopic cholecystectomy decreased significant complications but did not affect fatality rates.

PROSPECTIVE & COMPARATIVE STUDY OF VARIOUS TECHNIQUES USED IN THE MANAGEMENT OF LIVER ABSCESS IN THE BUNDELKHAND AREA

Background- This study was designed to determine the frequency of various clinical features in liver abscess and to evaluate the outcome of patients treated by medical management or surgical intervention in terms of hospital stay, cavity reduction time, cost and complications. Method- This is prospective comparative study of 85 patients, presented in in outpatient and emergency department of this hospital with the clinical features of liver abscess during the course of 1.5 years ( january 2020 to june 2021) were included. Patients divided in 4 groups on the basis of usg , patients having cavity size < 5cm were included in group A (n=10) and subjected to conservative management only, patients having cavity size > 5cm underwent percutaneous drainage either by needle aspiration group B (n=21) having volume <100ml or by catheter drainage group D (n=39) having vol>100ml with appropriate antibiotic. Patients with ruptured cavity and signs of peritonitis were included in group C (n=15) and laparotomy was done.outcome of the treatments was evaluated in terms of duration of hospital stay, 50% reduction of cavitysize, total /near total reduction of cavity size, success rate, complication rate and cost. ANOVA test was used to analyze the parameters and determine the results. Result- The most common signs and symptoms were, abdominal pain and right hypochondriac tenderness present in 100% and 78.8% of cases respectively. The success rate of catheter drainage is significantly better (>90%) than other groups (p=0.04) and this group also showed earlier 50% cavity reduction time 7. 4 days, complete cavity reduction time 22.4 days least hospital stay 9.7 days, significantly low complication rate 10.2% than others (p=<0.005) and is most cost effective with avg cost of Rs 2100. Conclusion- Among all the interventions percutaneous pig tail insertion with antibiotic coverage is the best way to treat large liver abscess with thick pus. In case of ruptured liver abscess open surgical method is ideal.

PROSPECTIVE & COMPARATIVE STUDY OF VARIOUS TECHNIQUES USED IN THE MANAGEMENT OF LIVER ABSCESS IN THE BUNDELKHAND AREA

Background- This study was designed to determine the frequency of various clinical features in liver abscess and to evaluate the outcome of patients treated by medical management or surgical intervention in terms of hospital stay, cavity reduction time, cost and complications. Method- This is prospective comparative study of 85 patients, presented in in outpatient and emergency department of this hospital with the clinical features of liver abscess during the course of 1.5 years ( january 2020 to june 2021) were included. Patients divided in 4 groups on the basis of usg , patients having cavity size < 5cm were included in group A (n=10) and subjected to conservative management only, patients having cavity size > 5cm underwent percutaneous drainage either by needle aspiration group B (n=21) having volume <100ml or by catheter drainage group D (n=39) having vol>100ml with appropriate antibiotic. Patients with ruptured cavity and signs of peritonitis were included in group C (n=15) and laparotomy was done.outcome of the treatments was evaluated in terms of duration of hospital stay, 50% reduction of cavitysize, total /near total reduction of cavity size, success rate, complication rate and cost. ANOVA test was used to analyze the parameters and determine the results. Result- The most common signs and symptoms were, abdominal pain and right hypochondriac tenderness present in 100% and 78.8% of cases respectively. The success rate of catheter drainage is significantly better (>90%) than other groups (p=0.04) and this group also showed earlier 50% cavity reduction time 7. 4 days, complete cavity reduction time 22.4 days least hospital stay 9.7 days, significantly low complication rate 10.2% than others (p=<0.005) and is most cost effective with avg cost of Rs 2100. Conclusion- Among all the interventions percutaneous pig tail insertion with antibiotic coverage is the best way to treat large liver abscess with thick pus. In case of ruptured liver abscess open surgical method is ideal.

Analysis and Comparative Study of Catheter Drainage or Needle Aspiration in Management of Liver Abscess

Background: Liver abscess is common cause of illness in developing nations. Even with the advance investigation like ultrasonography, the diagnosis is still delayed due to the nonconclusive manifestations of disease and for that reason the tentative diagnosis is important. Methods: 60 patients were selected from L.G. HOSPITAL, Ahmedabad. Study was conducted during the period from June 2020 to October 2021. Results: Percutaneous catheter drainage is having less compliance compared to needle aspiration. Repeated procedures needed to improve the success of percutaneous needle aspiration 56.66% of the subjects presented with complications in USG guided needle aspiration group whereas only 26.66% of people presented with complications in USG guided pigtail catheter drainage group. The most common complication in needle aspiration group was re-accumulation leading to repeated aspiration 40%. The of the most common complication in catheter drainage group is blockage of drain due to thick pus 10%. Conclusions: USG guided catheter drainage and USG guided needle aspiration are equally efficient in the management of significant sized liver abscesses.

Ultrasound-guided Percutaneous Drainage of Intra-abdominal Collection and its Clinical Outcome: A Prospective Interventional Study

Introduction: Intra-abdominal collections are abscesses that occur within the peritoneal cavity, the pelvis or behind the peritoneum (retroperitoneum) or intra-parenchymal. They are common complications of colorectal disease, particularly inflammatory bowel disease, malignancy and trauma. Ultrasound is very useful in establishing the diagnosis, quantification and localisation of intraabdominal abscesses. Open Surgical Drainage (SD) used to be the traditional treatment protocol. Recently however, percutaneous drainage procedures are becoming an essential therapeutic strategy in the treatment of this condition. Aim: To study the therapeutic efficacy of ultrasound-guided drainage of abdominal abscess and to compare it with open SD. Materials and Methods: A prospective interventional study was conducted in 94 patients with intra-abdominal abscess at Gauhati Medical College and Hospital, Guwahati, Assam, India, in between July 2019 to June 2020 who were randomly allocated into two groups and underwent respective procedures. The first group was Percutaneous Catheter Drainage (PCD) and second group was open Surgical Drainage (SD) group. Patient demographics, symptoms, aetiologies and locations of the collections as well as duration of hospital stay, success rate, and complications were analysed. Results of radiological findings were tabulated, evaluated and collated between both the groups. Statistical Package for Social Sciences (SPSS) software 21.0 version was used for analysing data and p-value <0.05 was considered significant. Results: For abdominal collections and abscesses, ultrasound guided percutaneous drainage was successful in 96.8% of the patients whereas it was successful in 80% cases in the SD group. Complications were more frequently encountered in patients who underwent open SD (16.70%) compared to percutaneous drainage (12.40%) which was significant (p-value 0.0136). The average duration of stay for the group undergoing percutaneous drainage was 9.13±1.62 days which was shorter than for the group undergoing SD was 11.10±1.75 days (p-value <0.001). The overall rate of failed percutaneous drainage was 3.2% as compared to SD where it was 20%. Conclusion: This study concluded that image-guided percutaneous drainage has lesser complications and higher success rate for abdominal collections/abscesses as compared to SD. Due to lower mortality rates as well as shorter duration of hospitalisation than open SD it can replace the traditional open or laparoscopic approach of drainage in most cases.

USG GUIDED PERCUTANEOUS NEEDLE APIRATION VERSUS USG GUIDED PIGTAIL CATHETER DRAINAGE IN THE MANAGEMENT OF LIVER ABSCESS - A PROSPECTIVE RANDOMISED CONTROLLED STUDY

Background: The aim of this study was to determine and compare the therapeutic effectiveness and safety of USG guided percutaneous continuous catheter drainage and USG guided percutaneous needle aspiration in the treatment of liver abscess in Trichy. Methods: This is a prospective randomised comparative study of 50 patients, presented in outpatient and emergency department at the hospital, randomised equally into two groups, percutaneous needle aspiration and pigtail catheter drainage. The effectiveness of their treatment was measured in terms of duration of hospital stay, time taken for improvement of clinical symptoms, time taken for 50% reduction in cavity size and total or near total reduction of abscess cavity. Independent t-test was used to analyse these parameters. Results: The success rate was significantly better in catheter drainage group. Patients in pigtail catheter drainage group showed earlier clinical improvement (p 0.000) and 50% reduction in abscess cavity volume (p 0.000) and near total reduction of abscess cavity was earlier (p 0.019) as compared to those who underwent percutaneous needle aspiration. Conclusion: Our study concludes that percutaneous catheter drainage is a better modality as compared to percutaneous needle aspiration in respect to clinical improvement, reduction of cavity and success rate.

Ultrasound-guided percutaneous drainage as an alternative to surgery in treating breast abscesses

Objectives: The aim of this study was to assess whether ultrasound-guided (US-guided) percutaneous drainage of breast abscesses could be used as an alternative to surgery. Methods: We performed a retrospective study. Twenty patients were included in the study who were diagnosed as having a non-specific breast abscess. Eleven patients underwent surgery whereas nine patients were treated with US-guided drainage. Ultrasonographic findings, results of treatment and follow-up were evaluated between the two groups. Results: In the US-guided drainage group, 5 patients were treated with needle aspiration and 4 were treated with catheter drainage. All cases within the needle aspiration group totally recovered. However, one case within the catheter drainage group failed. The total success rate of US-guided drainage was 88.8%. The median follow-up period was 21.0 days in the US-guided drainage group and 45.0 days in the surgical drainage group. There were no statistically significant differences in terms of recovery (p = 0.450) and follow-up periods (p = 0.112) between the surgical drainage and US-guided drainage groups. Conclusions: US-guided percutaneous drainage may be preferred as a first method of choice in treatment of a breast abscess. The most appropriate approach to breast abscess treatment will be possible with a multidisciplinary approach of surgery and radiology.

A dilemma over percutaneous catheter drainage or percutaneous needle aspiration as first-line management of liver abscess

Background: The aim of the study was to evaluate the clinical presentation and to investigate the effectiveness of percutaneous catheter drainage in comparison to needle aspiration in the treatment of liver abscesses of size more than 5 cm in diameter. Material and Methods: This was a prospective randomized comparative study of 60 patients, presented in outpatient and admitted at the hospital, randomized equally into two groups, percutaneous needle aspiration and percutaneous catheter drainage. The effectiveness of either treatment was measured in terms of duration of hospital stay, days to achieve clinical improvement and total/near total resolution of abscess cavity. Independent t- test was used to analyze these parameters. Results: Percutaneous catheter drainage was successful in all the 30 cases. On the other hand, USG guided percutaneous needle aspiration was successful only in 24 of 30 patients (P=0.005). Out of these 24 patients successfully treated, 6 patients required only one aspiration, 12 required two aspirations, and 6 required three aspirations. The 6 patients who did not show clinical improvement and / or decrease in cavity size despite 3 aspirations were taken as failures. In the PNA group, on comparing the cavity volumes the mean cavity volume in those who were successfully treated was 200 ml which was significantly less than those failing treatment; the mean volume being 400 ml. The patients in PCD group showed earlier clinical improvement (P=0.043) and decrease in abscess cavity volume (P=0.001) as compared to those who underwent PNA. In the present study, the success rate was significantly better in percutaneous catheter drainage group (P=0.005) than needle aspiration. The patients in percuaneous catheter drainage group showed earlier clinical improvement (P=0.043) as compared to those who underwent percutaneous needle aspiration. Conclusion: In the present study, percutaneous catheter drainage is found to be more effective than percutaneous needle aspiration for large liver abscesses of size 5 cm or more in diameter. The clinical improvement is also faster in PCD group than PNA group of the present study.

Treatment of Liver Abscess: A Comparison of Catheter Drainage and Needle Aspiration

Background The aim of the study was to evaluate the clinical presentation, and to investigate the effectiveness of continuous catheter drainage in comparison to needle aspiration in the treatment of liver abscesses. Method This is a comparative study of 50 patients, presented in outpatient and emergency department at the hospital,equally into two groups, percutaneous needle aspiration and pigtail catheter drainage. The effectiveness of either treatment was measured in terms of duration of hospital stay, days to achieve clinical improvement, 50% reduction in abscess cavity size and total/near total resolution of abscess cavity. Results The success rate was significantly better in catheter drainage group. The patients in pigtail catheter drainage group showed earlier clinical improvement and decrease in abscess cavity volume as compared to those who underwent percutaneous needle aspiration. Conclusions Percutaneous catheter drainage is a better modality as compared to percutaneous needle aspiration especially in larger abscesses which are partially liquefied or with thick pus.

Treatment of Liver Abscess: A Comparison of Catheter Drainage and Needle Aspiration

Background The aim of the study was to evaluate the clinical presentation, and to investigate the effectiveness of continuous catheter drainage in comparison to needle aspiration in the treatment of liver abscesses. Method This is a comparative study of 50 patients, presented in outpatient and emergency department at the hospital,equally into two groups, percutaneous needle aspiration and pigtail catheter drainage. The effectiveness of either treatment was measured in terms of duration of hospital stay, days to achieve clinical improvement, 50% reduction in abscess cavity size and total/near total resolution of abscess cavity. Results The success rate was significantly better in catheter drainage group. The patients in pigtail catheter drainage group showed earlier clinical improvement and decrease in abscess cavity volume as compared to those who underwent percutaneous needle aspiration. Conclusions Percutaneous catheter drainage is a better modality as compared to percutaneous needle aspiration especially in larger abscesses which are partially liquefied or with thick pus.

Laparoscopic cholecystectomy versus percutaneous catheter drainage for acute cholecystitis in high risk patients (CHOCOLATE): multicentre randomised clinical trial

ObjectiveTo assess whether laparoscopic cholecystectomy is superior to percutaneous catheter drainage in high risk patients with acute calculous cholecystitis.DesignMulticentre, randomised controlled, superiority trial.Setting11 hospitals in the Netherlands, February 2011 to...

Mo1152 COMPARING MORTALITY AND MAJOR COMPLICATIONS WITH ENDOSCOPIC DRAINAGE VS PERCUTANEOUS DRAINAGE IN PATIENTS WITH ACUTE INFECTED NECROTIZING PANCREATITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Acute pancreatitis can lead to necrosis of the pancreatic parenchyma. Infected necrotizing pancreatitis requires debridement, which traditionally has been performed with the surgical step-up approach, which includes percutaneous drainage, followed by open surgery if needed. Endoscopic catheter drainage in evolving as a promising alternative treatment option. This is a meta-analysis to pool the evidence for endoscopic (E group) versus percutaneous drainage (P group) in managing acute infected necrotizing pancreatitis patients. The primary outcome was to compare the mortality and major complications in the treatment groups. Study Selection Criteria: Prospective, retrospective and randomized control trials comparing Endoscopic drainage and percutaneous drainage in the patients with Acute Necrotizing Pancreatitis were included in the analysis. Data collection and extraction: Articles were searched in Pubmed, Ovid journals, Medline, Google Scholar, Cochrane Central Register for Controlled trials & Database of Systematic Review. Two reviewers independently searched and extracted data. Any differences were resolved with mutual agreement. Pooled proportions were calculated using both Mantel-Haenszel method (fixed effects model). The heterogeneity among studies was tested using Cochran’s Q test based upon inverse variance weights. Initial search identified 486 reference articles, of which 23 articles were selected and reviewed. Three studies (N=184) were selected which met the inclusion criteria were included in the analysis. Median age of the patients was 62 years, predominantly male population (64%). P for chi-squared heterogeneity for all the pooled accuracy estimates was >0.10. Pooled odds ratio by fixed effects comparing mortality and major complications in endoscopic versus percutaneous group was 0.89 (95% CI = 0.35 to 2.20). Pooled odds ratio by fixed effects comparing major complications in E group versus P group was 0.97 (95% CI = 0.48 to 1.94). Publication bias calculated using Harbord-Egger: bias gave a value of -2.12 (92.5% CI = -9.96 to 5.73) P = 0.26. The mortality and major complication rates seem to be similar in endoscopic catheter drainage group and percutaneous catheter drainage group for treating acute infected necrotizing pancreatitis.

Treatment of liver abscesses: A prospective randomized trial

Background: The aim of the study was to evaluate the clinical presentation, and to investigate the effectiveness of continuous catheter drainage in comparison to needle aspiration in the treatment of liver abscesses. Methods: This is a prospective randomized comparative study of 60 patients, presented in outpatient and emergency department at the hospital, randomized equally into two groups, percutaneous needle aspiration and pigtail catheter drainage. The effectiveness of either treatment was measured in terms of duration of hospital stay, days to achieve clinical improvement, 50% reduction in abscess cavity size and total/near total resolution of abscess cavity. Independent t-test was used to analyze these parameters. Results: The success rate was significantly better in catheter drainage group (P=0.006). The patients in pigtail catheter drainage group showed earlier clinical improvement (P=0.039) and 50% decrease in abscess cavity volume (P=0.000) as compared to those who underwent percutaneous needle aspiration. Conclusion: Percutaneous catheter drainage is a better modality as compared to percutaneous needle aspiration especially in larger abscesses which are partially liquefied or with thick pus.

Treatment of necrotizing acute pancreatitis with peritoneal lavage and dialysis by a new simplified technique insert catheters: One retrospective study.

Peritoneal lavage and dialysis is an approach to treat necrotizing acute pancreatitis as it removes dialyzable toxins and reduces severe metabolic disturbances. Successful catheter implantation is important for delivering adequate peritoneal lavage and dialysis. The aim of the present study was to describe a new modified percutaneous technique for the placement of peritoneal dialysis catheters and assess the effectiveness and safety of peritoneal lavage and dialysis used for treatment of necrotizing acute pancreatitis. We conducted a retrospective data review of 35 patients of necrotizing acute pancreatitis from January 2010 to December 2014 in Jilin City Central Hospital and The First Affiliated Hospital of ZheJiang University. In total, 18 patients underwent peritoneal lavage and dialysis after inserting catheters by our new technique (group A), whereas 17 patients underwent ultrasound-guided percutaneous catheter drainage (group B). By analyzing the patients’ data, the drainage days and mean number of hours between the debut of the symptoms and the hospital admission were lower in group A (P < 0.05, P < 0.05, respectively). The complication rate of 5.6 and 17.6%, respectively (P = 0.261), and a mortality rate of 16.7 and 5.9% for each group, respectively (P = 0.316). Likewise, hospitalization time was similar for the group A: 31 ± 25.3 days compared with 42.8 ± 29.4 days in the group B (P = 0.211). Peritoneal lavage and dialysis can be used in necrotizing acute pancreatitis, and our new modified percutaneous technique offers the same complication and mortality rate as ultrasound-guided drainage but with a shorter drainage days.

Liver abscess: catheter drainage v/s needle aspiration

Background: The aim of the study was to evaluate the clinical presentation, and to investigate the effectiveness of continuous catheter drainage in comparison to needle aspiration in the treatment of liver abscesses. Methods: This is a comparative study of 121 patients, presented in outpatient and emergency department at the hospital, randomized double blind trial was done and divide into two groups (percutaneous needle aspiration and pigtail catheter drainage.) about which surgeon did not knew about the division it was marked by evaluator. The effectiveness of either treatment was measured in terms of duration of hospital stay, days to achieve clinical improvement, reduction in abscess cavity size and total/near total resolution of abscess cavity. Results: The success rate was significantly better in catheter drainage group. The patients in pigtail catheter drainage group showed earlier clinical improvement and decrease in abscess cavity volume as compared to those who underwent percutaneous needle aspiration. Conclusions: Percutaneous catheter drainage is a better modality as compared to percutaneous needle aspiration especially in larger abscesses which are partially liquefied or with thick pus.

Abdominal paracentesis drainage ahead of percutaneous catheter drainage benefits patients attacked by acute pancreatitis with fluid collections: a retrospective clinical cohort study.

The efficacy and safety of ultrasound-guided abdominal paracentesis drainage ahead of percutaneous catheter drainage as the new second step of a step-up approach are evaluated. The observed parameters were compared between groups including mortality, infection, organ failure, inflammatory factor levels, indexes of further interventions, and drainage-related complications. This retrospective study included 102 consecutive patients with acute pancreatitis from June 2009 to June 2011. In this step-up approach, all patients subsequently received medical management, percutaneous catheter drainage (with or without previous abdominal paracentesis drainage), and necrosectomy if necessary according to indications. The patients were divided into two groups: 53 cases underwent abdominal paracentesis drainage followed by percutaneous catheter drainage (abdominal paracentesis drainage + percutaneous catheter drainage group) and 49 cases were managed only with percutaneous catheter drainage (percutaneous catheter drainage-alone group). The demographic data and severity scores of the two groups were comparable. The mortality rate was lower in the abdominal paracentesis drainage + percutaneous catheter drainage group (0%) than the percutaneous catheter drainage-alone group (8.2%) (p = 0.050). Compared with the percutaneous catheter drainage-alone group, the laboratory variables of the abdominal paracentesis drainage + percutaneous catheter drainage group decreased more rapidly, the mean number of failed organs was lower, and the interval from the onset of disease to further interventions was much longer. However, there was no significant difference in the prevalence and duration of infections between the two groups. Application of abdominal paracentesis drainage ahead of percutaneous catheter drainage is safe and beneficial to patients by reducing inflammatory factors, postponing further interventions, and delaying or avoiding multiple organ failure.

Analysis on the effect of treatment of octreotide combined with percutaneous catheter drainage on Pancreatic Pseudocyst

Objective To observe the effect of octreotide combined with percutaneous catheter drainage on pancreatic pseudocyst （ PPC ） .Methods 89 patients choosen with PPC were randomly divided into the octreotide combined with percutaneous catheter drainage group（observation group,n=43） and octreotide group （control group, n=46）.The control group were subcutaneous injected octreotide 0.1mg q 8 h.The observation group were subcutane-ous injected octreotide 0.1mg q 8 h with ultrasound or CT-guided percutaneous drainage for 4 weeks to place more drainage tubes when there were multiple cysts,drainage not free when washing drainage tube and drainage tube posi-tion adjustment.After 4 weeks rechecked the pancreas CT and curative effect was analyzed.Results The observation group cure rate and total effective rate were 65%,100%,the average hospitalization time was （16.8 ±12.1） d.The control group were 39%,85%,（26.8 ±19.4） d,the differences between the two groups were statistically significant（χ2 =6.01,χ2 =7.10,t=2.89,P〈0.05,P〈0.01）.Conclusion Octreotide combined percutaneous catheter drainage on PPC has good curative effect,small trauma,high success rate,less complications,shorter hospitalization time.It is the preferred method for the treatment of PPC. Key words: Pancreatic pseudocyst; Octreotide; Drainage

Percutaneous treatment of large pyogenic liver abscess

Surgical drainage has been the traditional mode of treatment of pyogenic liver abscess but this was replaced by IV broad-spectrum antibiotics and imaging-guided percutaneous drainage either via needle aspiration or percutaneous catheter drainage (CD). There is a debate about which is better intermittent needle aspiration or CD.Our objective is to compare the outcome of CD versus intermittent needle aspiration of pyogenic liver abscess and to compare the single step Trocar technique versus the modified Seldinger technique. Patients and methods88 patients, 65 men and 23 women, mean age 44.6 (18–73) years had pyogenic liver abscess. Patients were divided in two groups randomly; aspiration group with maximum of three attempts and the CD group. Ultrasound or CT was used. ResultsAspiration was successful in 60% of cases (26/43). CD was successful in 98% (44/45). Three patients were treated by surgical drainage (two patients of the aspiration group and one of the CD group) with favorable outcome. Both Seldinger and single step Trocar techniques were comparable as regards outcome and procedure-related pain but the procedure time of Trocar was significantly shorter. No major complications were encountered. ConclusionCD is more efficient than needle aspiration. Aspiration can be used for simple small abscesses. Trocar technique is less time-consuming than the Seldinger technique.

A comparison of traditional incision and drainage versus catheter drainage of soft tissue abscesses in children

Background/Purpose Soft tissue infections are increasingly being seen for surgical management, which is associated with painful dressing changes, lost days at school, time away from family, and scarring, which can have a great impact on both child and caretaker. We postulated that a drainage technique using a modified Pezzar catheter would be associated with shorter hospital stays and less wound care. Methods A consecutive series of 400 children with soft tissue abscesses was evaluated from April 2007 to October 2008. Children were managed according to the operating surgeon's preference. Children remained in the hospital until they were afebrile and the wounds could be adequately managed at home. Drains were removed 1 week after surgery in clinic. Results There were no treatment failures. Three hundred twenty-two children were managed with standard incision and drainage (I&D) and 78 patients with catheter drainage. Twenty-two children in the catheter drainage group (28%) required hospitalization of greater than 1 day compared with 151 children (47%) in the I&D group ( P = .001, Fisher exact test). Thirty-four percent of the children managed with I&D required packing at home, which was required in none of the patients managed with catheter drainage. Patient age, catheter drainage, and site of the lesion were associated independently with shorter hospital stays. Conclusion We conclude that catheter drainage of soft tissue abscesses in children is safe and effective. Catheter drainage is associated with a decreased hospital stay. Other factors related to shorter hospital stays include age of the patient and the site of soft tissue abscess.

Perirectal abscess in Crohn's disease

The role of surgical intervention in the treatment of patients with anorectal Crohn's disease is controversial. To clarify the success of aggressive drainage and the subsequent clinical course of patients with Crohn's disease and perirectal abscesses, the authors reviewed the records of 38 patients who presented with this condition during an eight-year period. Twenty-two male and 16 female patients (median age, 32 years; range, 17 to 61 years) with clinically or pathologically confirmed Crohn's disease of the bowel underwent operation for perirectal abscesses. Thirty-two percent of patients had no previous history of anorectal Crohn's disease. Thirty simple abscesses and 8 complex horseshoe abscesses were treated. At operation, 53 percent of patients underwent incision and drainage whereas 26 percent received loop indwelling drains and 21 percent had mushroom catheters placed. After resolution of the index abscess, recurrent abscesses occurred in 45 percent of the patients who underwent catheter drainage and 56 percent of the patients who underwent incision and drainage. More importantly, 44 percent of the incision and drainage group and only 31 percent of the catheter drainage group required subsequent proctectomy to control perineal sepsis. The healing time of the perineal wound was longer than six months in 83 percent of patients requiring rectal excision. We concluded that long-term catheter drainage may offer substantial benefit in the overall outcome of the treatment of patients with Crohn's disease and perirectal abscess.