Surgical site infection rate is lower in laparoscopic than open colorectal surgery

Howard, Dominic P J; Datta, Ginni; Cunnick, Giles; Gatzen, Christopher; Huang, Andrew

doi:10.1111/j.1463-1318.2009.01817.x

Cited by 47 publications

(39 citation statements)

References 19 publications

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“…The reasons for this are not immediately clear; however, it should be noted that a SSI rate of 8.0% amongst open resections is lower than the rate usually quoted in the literature. 7,9 In contrast, our laparoscopic SSI rate is similar to that of other studies. 7,9 The use of pre-operative skin preparation is common in many departments; however, its benefit is controversial.…”

Section: Discussionsupporting

confidence: 90%

“…7,9 In contrast, our laparoscopic SSI rate is similar to that of other studies. 7,9 The use of pre-operative skin preparation is common in many departments; however, its benefit is controversial. The aim of washing the area is to reduce the volume of resident bacteria and this has been demonstrated in trials.…”

Section: Discussionsupporting

confidence: 90%

“…[7][8][9] In our series, laparoscopic SSI rates remain higher than SSI in our open series (11.6% vs 8.0%) although not significantly so. The reasons for this are not immediately clear; however, it should be noted that a SSI rate of 8.0% amongst open resections is lower than the rate usually quoted in the literature.…”

Section: Discussioncontrasting

confidence: 63%

“…6 Laparoscopic colorectal surgery is associated with a lower SSI rate than open surgery. 7,8 We report on our experience switching from a policy of highly selective laparoscopic to unselected laparoscopic approach for elective colorectal surgery and note its effect on SSI rates.…”

mentioning

confidence: 99%

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Back to basics – cutting the cord on umbilical infections

Sharples

McArthur

McNamara

et al. 2011

annals

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INTRODUCTION Surgical site infections (SSIs) are a significant cause of postoperative morbidity with laparoscopic surgery associated with lower SSI rates. However, a departmental change in our unit to increased laparoscopic colorectal surgery resulted in increased wound infection rates at umbilical specimen extraction sites, the cause of which we attempted to elucidate. SUBJECTS AND METHODS Prospectively collected data over an 18-month period (April 2008 to September 2009) for laparoscopic colorectal operations in a busy teaching hospital were retrospectively analysed, focusing on operation performed, whether pre-operative skin cleansing was employed, nature of specimen extraction excision, and rate of umbilical wound infection. Comparison was made with open colorectal procedures performed in the preceding year. RESULTS In total, 275 laparoscopic colorectal operations were performed. Over the first 8 months there was a significant increase in infection rates when compared with open procedures over a similar time period (23.5% vs 8.0%; P = 0.0001). Changing practice to use pre-operative skin cleansing and an incision that skirted around, as opposed to traversing, the umbilicus reduced umbilical infection rates significantly from 23.5% to 11.6% (P = 0.01). Patients undergoing right hemicolectomy benefitted more (reduction of 30.0% to 6.9%; P = 0.04) than those undergoing anterior resection (26.8% vs 15.6%, P = 0.13). CONCLUSIONS Umbilical incisions, when extended for specimen extraction, are particularly prone to infection following colorectal surgery but rates can be reduced by simple measures such as pre-operative umbilical cleansing and avoidance of the umbilicus in the incision, without the need for drastic and costly changes in technique or antibiotic prophylaxis.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 90%

Section: Discussioncontrasting

confidence: 63%

mentioning

confidence: 99%

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Back to basics – cutting the cord on umbilical infections

Sharples

McArthur

McNamara

et al. 2011

annals

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show abstract

“…Collections requiring treatment were present five times more frequent in obese than in nonobese patients after left colectomies [36]. Other studies imply that obese patients are at increased risk of developing pulmonary complications [37], incisional hernia, and surgical site infections [38,39]. For SILS, a recent article found an increased risk of wound healing complications in obese patients [40].…”

Section: Introductionmentioning

confidence: 96%