A Comparison of Abdominal Cavity Bacterial Contamination of Laparoscopy and Laparotomy for Colorectal Cancers

Abstract

Background/Aim: To compare intra-abdominal remnant bacterium between laparotomy and laparoscopic colorectal surgery. Methods: 72 patients with nonobstructive colorectal cancer were divided into two groups: laparotomy (47 cases) and laparoscopic surgery (25 cases). At the beginning of the operation just after the laparotomy incision was made or the trocars were inserted, 10 ml saline was irrigated into the Douglas pouch and collected through Nelaton’s catheter. Just before closing the wound, 10 ml saline was collected in the same way as the initial lavage in both groups. The collected saline as a specimen was determined to obtain the number of surviving bacterium. Results: No growth of bacteria was observed at the beginning of both operations. The remnant bacterial detection rates from the lavage fluid collected just before closing the wound were 23 of 47 cases (49%) in the laparotomy group and 7 of 25 cases (28%) in the laparoscopic surgery group; higher detection was observed in the laparotomy group. The mean bacteria cell counts after lavage were 4.6 × 10⁶ CFU/ml of aerobic bacteria and 1.9 × 10³ CFU/ml of anaerobic bacteria in the laparotomy group and 1.8 × 10⁴ CFU/ml of aerobic bacteria and 1.6 × 10² CFU/ml in the laparoscopic surgery group: the laparotomy group demonstrated an apparently higher number of remnant bacterium. Conclusions: In colorectal resections, laparoscopic surgery demonstrated a lower incidence of intra-abdominal contamination than laparotomy.

Laparo-Endoscopic Single-Site (LESS) with Transanal Natural Orifice Specimen Extraction (NOSE) Sigmoidectomy: A New Step before Pure Colorectal Natural Orifices Transluminal Endoscopic Surgery (NOTES®)

“…Contamination of peritoneal cavity in colorectal surgery is frequent even in conventional non-NOSE procedures. 18 In our experience on transanal NOSE sigmoidectomies, 100% of culture was positive; however, no patients developed significant intra-abdominal infections. To fully assess this issue, a prospective study comparing peritoneal contamination in NOSE and non-NOSE colorectal procedures would be needed.…”

Prospective evaluation of peritoneal fluid contamination following transabdominal vs. transanal specimen extraction in laparoscopic left-sided colorectal resections

“…We published a measurable contamination rate of 100%, with no cases of clinically significant peritoneal infection [7]. Bacterial contamination of the peritoneal cavity is frequent in colorectal laparoscopic procedures [6], but it is unknown whether NOSE leads to increased levels of contamination that may manifest as clinically significant peritoneal infection. Although we found a higher rate of peritoneal fluid contamination in NOSE patients, there were no significant differences in clinical outcomes relative to those of the standard laparoscopic approach.…”

“…Measurable bacterial contamination is known to occur frequently in non-NOSE procedures [6]. We recently reported a prospective evaluation of peritoneal contamination risk in our series of laparoscopic resections with transanal NOSE sigmoidectomies for diverticulitis [7] and found that although contamination occurred invariably, it did not translate into infectious morbidity.…”

Laparoscopic resection with transanal specimen extraction for sigmoid diverticulitis

“…Although dramatic in its initial concept, if NOTES is to emerge as a distinct, useful, operative approach, it will probably do so best as a result of the gradual evolution of adapted laparoscopic (and endoscopic) practice. Similarly, the evolution of laparoscopic techniques is already benefiting from the NOTES endeavour, as it is increasingly clear that the contamination (as opposed to overt infection) that may result from controlled opening of the bowel has been well tolerated in both experimental and initial, limited, clinical experience1, 8, 17.…”