Impact of Laparoscopic Colorectal Resection on Surgical Site Infection

Poon, Jensen T. C.; Law, Wai‐Lun; Wong, Ivan Wc; Ching, Patricia; Wong, Lisa M.W.; Fan, Jicong; Lo, Oswens Siu-Hung

doi:10.1097/sla.0b013e31819279e3

Cited by 118 publications

(98 citation statements)

References 37 publications

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“…Laparoscopy has been demonstrated by many studies to decrease the postoperative wound complication rate [23]. A prospective study by Poon et al demonstrated a 50% decrease in surgical-site infections in patients who underwent laparoscopic versus open colorectal resection [24]. This study also demonstrated open colorectal resection as an independent risk factor for development of surgical-site infection with an odds ratio of 2.36 and 95% confidence interval of 1.1-5.3 [24].…”

Section: Discussionsupporting

confidence: 58%

Laparoscopic subtotal colectomy for medically refractory ulcerative colitis: the time has come

et al. 2010

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Section: Discussionsupporting

confidence: 58%

Laparoscopic subtotal colectomy for medically refractory ulcerative colitis: the time has come

et al. 2010

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“…[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: Discussionmentioning

confidence: 62%

“…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%

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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“…The combination of both multimodal rehabilitation protocols and minimally invasive surgery is probably the best way to minimize morbidity [41,42], although minimally invasive surgery itself was found to reduce the risk of anastomotic and pulmonary complications [43], surgical site infections [44], venous embolism [45], and other nonsurgical complications in general [46]. A lower morbidity rate of minimally invasive surgery was also found for patients older than 70 [47] indicating that high-risk patients in particular might benefit from this technique.…”

Section: Introductionmentioning

confidence: 87%