Reduced incidence of early complications of surgical wounds in laparoscopic surgery
Subgroup: Volume 9, Issue 2
Date: April 2007
Type: Short Communication
Start Page: 99
End Page: 103
- SA Fanaie Department of General Surgery,Baghyatollah University of Medical Sciences, Tehran, Tehran, Iran
- F Panahi Department of General Surgery,Baghyatollah University of Medical Sciences, Tehran, Tehran, Iran
- B Khorasani Department of General Surgery,Social Welfare and Rehabilitation University of Medical Sciences, Tehran, Tehran, Iran
- SM Khatami Department of General Surgery,Baghyatollah University of Medical Sciences, Tehran, Tehran
City, Province: Tehran, Tehran
Background: Wound-related complications are major sources of trouble in post-operative period and slow down the wound healing process. This study was performed to determine the incidence of early wound related complications in laparoscopic versus open abdominal surgeries.
Methods: Medical records of 104 elective laparoscopic (A) and 106 diagnosis matched open surgeries (B) including appendectomy, cholecystectomy, ventral hernia repair, and bariatric surgery were retrospectively reviewed between Jun 2002 and Jan 2005. Study data included patients’ sex, age, wound class, type of operation, and occurrence of early wound related complications. Surgical wounds were evaluated for presence of early complications during the post-op period and 10 to 15 days after the operation.
Results: The two groups were not different regarding age, sex and wound classes. Wound infection developed in 7 patients [RR: 0.06 (0.01-0.77) (95%CI)] and none in patients of group B. Incidence of Hematoma was similar in the two groups; one case in each. No patients in the two groups experienced seruma nor wound dehiscence. Gender, age, and wound classes were not associated with higher rates of wound complications.
Conclusion: Laparoscopic surgery significantly reduced the incidence of early wound complications, namely wound infection, and is a safe and efficient alternative to conventional open procedures.
Keywords: Wound complications; Laparoscopic surgery; Open surgery
Minimally invasive procedures has accepted widely because of smaller incision, least postoperative pain, lower rates of pulmonary complications, and most of all shorter hospital stay and quicker return to activities of daily work.1-4 This study aimed to assess incidence of early wound-related complications including hematoma, seruma, wound infection and dehiscence in laparoscopic versus open abdominal surgeries performed in our center.
Materials and Methods
Medical records in retrospective cohort study of 104 elective laparoscopic surgeries performed by the surgeons at Milad Hospital, were retrospectively reviewed between Jun 2002 and Jan 2005. The operations included laparoscopic appendectomy, cholecystectomy, ventral hernia repair, and bariatric surgery. To provide a relevant reference, 106 diagnoses matched open procedures over the same period.
Patients above 60 or those with underlying diseases including heart failure, diagnosed COPD, chronic liver diseases, diabetes, and those with history of chemotherapy or radiotherapy and patients previously treated with steroid drugs were excluded from the study. Surgical operations lasting for more than 2 hours and wounds found to be dirty during the operation were also excluded. All the operations were performed under general anesthesia by the same surgeon. Study data included patients’ sex, age, wound class, type of operation, and occurrence of early wound related complications. Surgical wounds were classified based on the presumed magnitude of the bacterial load at the time of surgery5 Class I included clean wounds with no infection, class II included clean contaminated wounds, in which a hollow viscous with indigenous bacterial flora was opened under controlled circumstances, and class III wounds were contaminated with extensive introduction of bacterial flora. Surgical wounds were evaluated for presence of early complications during the post-operative hospital stay, and re-examined 10 to 15 days after the operation in the ward or on the first follow up visit in the clinic.
Wound infection was defined as erythema or culture proven wound drainage, requiring either antibiotic administration or local wound care intervention.
Comparisons were made using Chi-Square or Student’s t test, whenever indicated. Odds ratios were calculated using 95% confidence intervals and P< 0.05 was considered significant.
The study comprised 210 patients, 130 females and 80 males, aged from 17-60 (mean 43.2±8). There were no significant age and mean gender differences between the two operation groups (Table 1). Classification of surgical wounds included 41 class I, 144 class II, and 25 class III wounds. The two groups did not differ in regard to wound classes. Wound related complications included hematoma in 2 and wound infections in 7 patients. There were no cases of seruma or wound dehiscence. The incidence of hematoma was similar in both groups including one episode in laparoscopic surgery (Hernia repair) and one case in the open operation group. All 7 cases of wound infections occurred in the open method, 1 with wound class I, 4 with class II, and 2 with class III. Risks of developing wound complications in operative methods and wound classes are presented in terms of odds ratio in Table 2. In general laparoscopy significantly reduced the risk of wound infection, but not hematoma, and early wound complications. Gender, age, and wound classes were not associated with higher rates of any wound related complications. In order to determine the independent effect of operation method on the complications, comparisons of the operative methods within each wound classes, showed reduced risk of wound infections with laparoscopic surgery.
Wound-related complications are major sources of trouble in post-operative period; they slow down the wound healing process, prolong the hospital stay, and their treatments impose large costs on the health services. In this study laparoscopic surgery significantly reduced the incidence of early wound complications [0.01 % vs. 0.08%; RR (95% CI)]: 0.17 (0.03-0.97). This was in concordance with the previous studies.2,4,6
Despite expected lower incidence of hematoma with laparoscopy due to minimal tissue damage, one case of hematoma occurred following an inguinal hernia repair. This may be explained by the presence of copious supply of blood vessels and lymphatics in the region. The reduced risk of wound infection in laparoscopy was so remarkable [RR (95%CI)]: 0.06 (0.01-0.77) that some studies have debated the necessity of antibiotic prophylaxis before basic laparoscopic surgeries.7 The most favorable results of laparoscopic methods in reducing the infection (3% vs 22%, respectively) have been reported with ventral hernia repairs.2 Wound infection incidence is also decreased following laparoscopic cholecystectomy (2.3% vs 6.3%, respectively),6 appendectomy8 and colorectal surgeries (0% vs 9.5%, respectively).9,10 Although one study has reported higher infection rates with laparoscopic colectomy (13.5% vs 10.9%), 10.8% of infections in our study has been in extraction site, and only 2.7% in the trocar site. For easy comparison, the incidence rate of wound infection among laparoscopic surgeries as well as open methods has been summarized in Table 3. Although laparoscopy have been outstanding in most digestive surgeries, its recommendation for more complex surgeries and those for cancer, awaits the development of well-established operative techniques and availability of appropriate equipments to ensure patients safety and excellent outcomes.
- Weeks JC, Nelson H, Gelber S, et al. The clinical outcome of surgical therapy (COST) study group. Short-term quality of life outcomes following laparoscopic assisted colectomy vs. open colectomy for colon cancer: a randomized clinical trial. JAMA 2002;287:321-8.
- Robbins SB, Pofahl WE, Gonzalez RP. Laparoscopic ventral hernia repair reduces wound complications. Am Surg 2001;67:896-900.
- Winslow ER, Fleshman JW, Birnbaum EH, Brunt LM. Wound complications of laparoscopic vs. open colectomy. Surg Endosc 2002;16:1420-5.
- Karim H, Chafik K, Karim K, et al. Risk factors for surgical wound infection in digestive surgery. Retrospective study of 3000 surgical wounds. Tunis Med 2000;78:634-40.
- Martone WJ, Nicholes RL. Recognition, prevention, surveillance, and management of surgical site infections. Clin Infect Dis 2001;33:S67-9.
- Zitser YG, Simchen E, Ferderber N, Freund HR. A trend for reduced 15-day wound infection and 6 months' mortality in laparoscopic relative to open cholecystectomy: the Israeli study of surgical infections. Clin Perform Qual Health Care 1997;5:116-22.
- Harling R, Moorjani N, Perry C, MacGowan AP, Thompson MH. A prospective, randomized trial of prophylactic antibiotics versus bag extraction in the prophylaxis of wound infection in laparoscopic cholecystectomy. Ann R Coll Surg Engl 2000;82:408-10.
- Meynaud-Kraemer L, Colin C, et al. Wound infection in open versus laparoscopic appendectomy. A meta-analysis. Int J Technol Assess Health Care 1999;15:380-91.
- Koh DCS, Wong KS, Sim R, et al. Laparoscopic assisted colon and rectal surgery–lessons learnt from early experience. Ann Acad Med Singapore 2005;34:223-8.
- Chuang SC, Lee KT, Chang WT, et al. Risk factors for wound infection after cholecystectomy. J Formos Med Assoc 2004;103:607-12.