Port site infection in laparoscopic surgery: A review of its management

Abstract

Laparoscopic surgery (LS), also termed minimal access surgery, has brought a paradigm shift in the approach to modern surgical care. Early postoperative recovery, less pain, improved aesthesis and early return to work have led to its popularity both amongst surgeons and patients. Its application has progressed from cholecystectomies and appendectomies to various other fields including gastrointestinal surgery, urology, gynecology and oncosurgery. However, LS has its own package of complications. Port site infection (PSI), although infrequent, is one of the bothersome complications which undermine the benefits of minimal invasive surgery. Not only does it add to the morbidity of the patient but also spoils the reputation of the surgeon. Despite the advances in the field of antimicrobial agents, sterilization techniques, surgical techniques, operating room ventilation, PSIs still prevail. The emergence of rapid growing atypical mycobacteria with multidrug resistance, which are the causative organism in most of the cases, has further compounded the problem. PSIs are preventable if appropriate measures are taken preoperatively, intraoperatively and postoperatively. PSIs can often be treated non-surgically, with early identification and appropriate management. Macrolides, quinolones and aminoglycosides antibiotics do show promising activity against the atypical mycobacteria. This review article highlights the clinical burden, presentations and management of PSIs in LS as shared by various authors in the literature. We have given emphasis to atypical mycobacteria, which are emerging as a common etiological agent for PSIs in LS. Although the existing literature lacks consensus regarding PSI management, the complication can be best avoided by strictly abiding by the commandments of sterilization techniques of the laparoscopic instruments with appropriate sterilizing agent.

Atypical mycobacterial infections following laparoscopic surgery

“…Mycobacterium chelonae, M. fortuitum) are widely distributed in soil and water, and can therefore contaminate hospital instruments. 2,3,4 The three patients described above presented with discharging sinuses in and around the port site of indolent onset without systemic manifestations 3-4 weeks after surgery.…”

“…Atypical mycobacterial infection at port sites is an increasing problem encountered in patients undergoing laparoscopic surgery and has been reported to cause nosocomial outbreaks. 1,2,3,4 It leads to increased morbidity and long term treatment. Multidrug resistance further complicates the problem.…”

A Study of Post Laparoscopic Port Related Complications

“…Although most of these complications are not life threatening, but definitely add a lot to the morbidity, affects the postoperative quality of life, and spoils the aesthesis of the surgery. [26] With this background the present study was carried out with an aim to determine the complications associated with ports after laparoscopic surgery. For this purpose, a prospective observational study was carried out in which a total of 310 patients undergoing different laparoscopic procedures were enrolled.…”

Evaluation of Port Site Infection Following Laparoscopic Cholecystectomy in a Government Teaching Hospital

“…involves any part of body excluding the skill incision, fascia or muscle layer that is opened or manipulated during operative procedure. 5,6 Out of 409 cases of Laparoscopic cholecystectomy which were analysed for P.S.I., nine cases were converted to open cholecystectomy of these six cases were converted due to encounter with Mirizzi type III, IV & V cases due to Bile duct injury and these nine cases were excluded from our study. All cases were given preoperative Ceftriaxone (1 gm) at the time of induction of anaesthesia and followed by one vial more after 12 hrs.…”