Use of retrieval bag in the prevention of wound infection in elective laparoscopic cholecystectomy: is it evidence-based? A meta-analysis

Abstract

BackgroundSurgical site infections complicate elective laparoscopic cholecystectomies in 2,4-3,2% of cases. During the operation the gallbladder is commonly extracted with a retrieval bag. We conducted a meta-analysis to clarify whether its use plays a role in preventing infections.MethodsInclusion criteria: elective cholecystectomy, details about the gallbladder extraction and data about local or systemic infection rate. Exclusion criteria: cholecystitis, jaundice, concurrent antibiotic therapy, immunosuppression, cancer. A comprehensive literature search of PubMed, Cochrane Library and MEDLINE databases was carried out independently by two researchers, according to the PRISMA guidelines and applying the GRADE approach. Terms used were (“gallbladder”AND(“speciment”OR“extraction”OR“extract”))OR(“gallbladder”OR“cholecystectomy”)AND(“bag”OR“retrieval|”OR|“endobag”OR“endocatch”).ResultsThe comprehensive literature revealed 279 articles. The eligible studies were 2 randomized trials and a multicentre prospective study. Wound infections were documented in 14 on 334 (4,2%) patients operated using a retrieval bag versus 16 on 271 (5,9%) patients operated without the use of a retrieval bag. The statistical analysis revealed a risk ratio (RR) of 0.82 (0.41–1.63 95% CI). Concerning sensitivity analysis the estimated pooled RR ranged from 0.72 to 0.96, both not statistically significant. Harbord test did not reveal the occurrence of small-study effect (p = 0.892) and the funnel-plot showed no noteworthy pattern.ConclusionsThe results of this review highlight the paucity of well-designed large studies and despite limitations related to the low level of evidence, our meta-analysis showed no significant benefit of retrieval bags in reducing the infection rate after elective laparoscopic cholecystectomy. In absence of acute cholecystitis, accidental intraoperative gallbladder perforation or suspected carcinoma their use, to date, may not be mandatory, so that, further studies focusing on complex cases are needed.Electronic supplementary materialThe online version of this article (10.1186/s12893-018-0442-z) contains supplementary material, which is available to authorized users.

Surgical glove use for specimen removal in laparoscopy, the cheapest available: a prospective study

“…No one method has been shown to be superior to another. 2 In an attempt to reduce costs, we began to use sterile, unpowdered, latex-free surgical gloves for retrieval. We found no disadvantage to their use.…”

Retained gallbladder secondary to retrieval bag rupture during laparoscopic cholecystectomy—A case report

“…Complications from bile and gallstone spillage are rare according to large studies looking at overall outcomes of laparoscopic cholecystectomies [[17], [18], [19]]. Regina and colleagues [20] recently performed a meta-analysis, which demonstrated that retrieval bags do not reduce the rate of infection during gallbladder extraction. However, their paper excluded cases of cholecystitis and suspected carcinoma, presenting a biased perspective against retrieval bags.…”

Why are we still using antibiotic prophylaxis in elective laparoscopic cholecystectomy for the low-risk groups? a review of literature

“…They also stated that lack of association between the bile and causing WI organisms suggests that WI does not depend on direct contact of the GB while extraction, instead the skin commensals play a part in it. 35 Neri et al compared two groups for PSI with and without topical AB and found out that the incidence of umbilical port site infection is less compared to the non-topical AB groups. In their trial, they applied Rifamycin after the closure of the wound at the end of the surgery and at 12, 24, 36, 48 and 72 hours maintaining full sterility.…”