Skip to main content
Top
Published in: Surgical Endoscopy 1/2017

01-01-2017

Effect of bag extraction to prevent wound infection on umbilical port site wound on elective laparoscopic cholecystectomy: a prospective randomised clinical trial

Authors: Jordi Comajuncosas, Judit Hermoso, Jaime Jimeno, Pere Gris, Rolando Orbeal, Antonio Cruz, David Parés

Published in: Surgical Endoscopy | Issue 1/2017

Login to get access

Abstract

Background

Laparoscopic cholecystectomy is the gold standard treatment for gallbladder stones. Complications due to laparoscopic procedure are rare, but rate of wound infection in some studies is about 8 %. From January 2007 to December 2008, 320 laparoscopic cholecystectomies were performed at our hospital, and in 4.7 % of them, wound infection of the umbilical trocar was identified. We believe that this infection rate could be lower and that it is necessary to implement a new technique to reduce the wound infection. The aim of the study was to evaluate the benefits of bag extraction of gallbladder to prevent the wound infection.

Methods

Two-arm, parallel, 1:1, randomised controlled trial (ISRCTN38095251). All patients suffering from symptomatic gallbladder stones of low risk were enrolled for this study and were divided into two groups in basics gallbladder extraction: with (80 patients) or, as usually, without bag (76 patients). All patients with cholecystitis or accidental gallbladder perforation were excluded. We compared all the results to establish whether meaningful differences were found.

Results

The final sample analysed (156 patients) consisted of 121 women and 35 men; there were 80 in the control group and 76 in the study group. There were 15 (9.6 %) diagnosed wound infections, eight cases in the study group and seven in the control group. There were no statistically significant differences.

Conclusions

The determinant of wound infection in elective laparoscopic cholecystectomy is not the direct contact of the gallbladder with the wound; therefore, bag extraction is not necessary.
Literature
1.
go back to reference Comajuncosas J et al (2014) Risk factors for umbilical trocar site incisional hernia in laparoscopic cholecystectomy: a prospective 3-year follow-up study. Am J Surg 207(1):1–6CrossRefPubMed Comajuncosas J et al (2014) Risk factors for umbilical trocar site incisional hernia in laparoscopic cholecystectomy: a prospective 3-year follow-up study. Am J Surg 207(1):1–6CrossRefPubMed
2.
go back to reference Mouret P (1991) From the first laparoscopic cholecystectomy to the frontiers of laparoscopic surgery: the future prospectives. Dig Surg 8:124–126CrossRef Mouret P (1991) From the first laparoscopic cholecystectomy to the frontiers of laparoscopic surgery: the future prospectives. Dig Surg 8:124–126CrossRef
3.
go back to reference Deziel DJ, Milikian KW, Economou SG et al (1993) Complicactions of laparoscopic cholecystectomy: a national survey of 4292 hospitals and an analysis of 77604 cases. Am J Surg 165:9–14CrossRefPubMed Deziel DJ, Milikian KW, Economou SG et al (1993) Complicactions of laparoscopic cholecystectomy: a national survey of 4292 hospitals and an analysis of 77604 cases. Am J Surg 165:9–14CrossRefPubMed
4.
go back to reference Triantafyllidis I et al (2009) Complications of laparoscopic cholecystectomy: our experience in a district general hospital. Surg Laparosc Endosc Percutan Tech 6:449–458CrossRef Triantafyllidis I et al (2009) Complications of laparoscopic cholecystectomy: our experience in a district general hospital. Surg Laparosc Endosc Percutan Tech 6:449–458CrossRef
5.
go back to reference Coda A, Bossoti M, Ferri F et al (2000) Incisional hernia and fascial defect following laparoscopic surgery. Surg Laparosc Endosc Percutan Tech 10:34–38CrossRefPubMed Coda A, Bossoti M, Ferri F et al (2000) Incisional hernia and fascial defect following laparoscopic surgery. Surg Laparosc Endosc Percutan Tech 10:34–38CrossRefPubMed
6.
go back to reference Mayol J, Garcia-Aguilar J, Ortiz-Oshiro E et al (1997) Risks of the minimal access approach for laparoscopic surgery: multivariate analysis of morbidity related to umbilical trocar insertion. World J Surg 21:529–533CrossRefPubMed Mayol J, Garcia-Aguilar J, Ortiz-Oshiro E et al (1997) Risks of the minimal access approach for laparoscopic surgery: multivariate analysis of morbidity related to umbilical trocar insertion. World J Surg 21:529–533CrossRefPubMed
7.
go back to reference Nassar AH, Ashkar KA, Rashed AA et al (1997) Laparoscopic cholecystectomyand the umbilicus. Br J Surg 84:630–633CrossRefPubMed Nassar AH, Ashkar KA, Rashed AA et al (1997) Laparoscopic cholecystectomyand the umbilicus. Br J Surg 84:630–633CrossRefPubMed
8.
go back to reference Azurin DJ, Go LS, Arroyo LR et al (1995) Trocar site herniation following laparoscopic cholecystectomy and the significance of an incidental preexisting umbilical hernia. Am Surg 61:718–720PubMed Azurin DJ, Go LS, Arroyo LR et al (1995) Trocar site herniation following laparoscopic cholecystectomy and the significance of an incidental preexisting umbilical hernia. Am Surg 61:718–720PubMed
9.
go back to reference Wirkowski A, Pesta W (2008) Pulapki cholecystektomii laparoskopowejd doswiadczenia wlasne. Wideochirurg Inne Tech Maloinwazyjne 3:179–185 Wirkowski A, Pesta W (2008) Pulapki cholecystektomii laparoskopowejd doswiadczenia wlasne. Wideochirurg Inne Tech Maloinwazyjne 3:179–185
10.
11.
go back to reference Ramachandran CS (1998) Umbilical hernial defects encountered before and after abdominal laparoscopic procedures. Int Surg 83:171–173PubMed Ramachandran CS (1998) Umbilical hernial defects encountered before and after abdominal laparoscopic procedures. Int Surg 83:171–173PubMed
12.
go back to reference Armañanzas L, Ruiz-Tovar J, Arroyo A, García-Peche P, Armañanzas E, Diez M, Galindo I, Calpena R (2014) Prophylactic mesh vs suture in the closure of the umbilical trocar site after laparoscopic cholecystectomy in high-risk patients for incisional hernia. A randomized clinical trial. J Am Coll Surg 218(5):960–968CrossRefPubMed Armañanzas L, Ruiz-Tovar J, Arroyo A, García-Peche P, Armañanzas E, Diez M, Galindo I, Calpena R (2014) Prophylactic mesh vs suture in the closure of the umbilical trocar site after laparoscopic cholecystectomy in high-risk patients for incisional hernia. A randomized clinical trial. J Am Coll Surg 218(5):960–968CrossRefPubMed
13.
go back to reference Harling R, Moorjani N, Perry C, MacGowan AP, Thompson MH (2000) A prospective, randomised trial of prophylactic antibiotics versus bag extraction in the prophylaxis of wound infection in laparoscopic cholecystectomy. Ann R Coll Surg Engl 82:408–410PubMedPubMedCentral Harling R, Moorjani N, Perry C, MacGowan AP, Thompson MH (2000) A prospective, randomised trial of prophylactic antibiotics versus bag extraction in the prophylaxis of wound infection in laparoscopic cholecystectomy. Ann R Coll Surg Engl 82:408–410PubMedPubMedCentral
14.
go back to reference McGuckin M, Shea JA, Schwartz JS (1999) Infection and antimicrobial use in laparoscopic cholecystectomy. Infect Control Hosp Epidemiol 20:624–626CrossRefPubMed McGuckin M, Shea JA, Schwartz JS (1999) Infection and antimicrobial use in laparoscopic cholecystectomy. Infect Control Hosp Epidemiol 20:624–626CrossRefPubMed
15.
go back to reference Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR (1999) Guidelines for prevention of surgical site infection, 1999: Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 20:250–278CrossRefPubMed Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR (1999) Guidelines for prevention of surgical site infection, 1999: Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 20:250–278CrossRefPubMed
16.
17.
go back to reference The Southern Surgeon’s Club (1991) A prospective analysis of 1518 laparoscopic cholecystectomies. N Engl J Med 324:1073–1078CrossRef The Southern Surgeon’s Club (1991) A prospective analysis of 1518 laparoscopic cholecystectomies. N Engl J Med 324:1073–1078CrossRef
18.
go back to reference Shindholimath VV, Seenu V, Parshad R, Chaudhry R, Kumar A (2003) Factors influencing wound infection following laparoscopic cholecystectomy. Trop Gastroenterol 24:90–92PubMed Shindholimath VV, Seenu V, Parshad R, Chaudhry R, Kumar A (2003) Factors influencing wound infection following laparoscopic cholecystectomy. Trop Gastroenterol 24:90–92PubMed
19.
go back to reference Uchiyama K et al (2003) Preoperative antimicrobial administration for prevention of postoperative infections in patients with laparoscopic cholecystectomy. Dig Dis Sci 48:1955–1959CrossRefPubMed Uchiyama K et al (2003) Preoperative antimicrobial administration for prevention of postoperative infections in patients with laparoscopic cholecystectomy. Dig Dis Sci 48:1955–1959CrossRefPubMed
20.
go back to reference Al-Abassi AA, Farghaly MM, Ahmed HL, Mobasher LL, Al-Manee MS (2001) Infections after laparoscopic cholecystectomy: effect of infected bile and infected gallbladder wall. Eur J Surg 167:268–273CrossRefPubMed Al-Abassi AA, Farghaly MM, Ahmed HL, Mobasher LL, Al-Manee MS (2001) Infections after laparoscopic cholecystectomy: effect of infected bile and infected gallbladder wall. Eur J Surg 167:268–273CrossRefPubMed
21.
go back to reference Chang WT et al (2006) The impact of the role of prophylactic antibiotics in elective laparoscopic cholecystectomy: a prospective randomized study. Am J Surg 191:721–725CrossRefPubMed Chang WT et al (2006) The impact of the role of prophylactic antibiotics in elective laparoscopic cholecystectomy: a prospective randomized study. Am J Surg 191:721–725CrossRefPubMed
22.
go back to reference Kuthe SA, Kaman L, Verma GR, Singh R (2006) Evaluation of the role of prophylactic antibiotics in elective laparoscopic cholecystectomy a prospective randomized trial. Trop Gastroenterol 27(1):54–57PubMed Kuthe SA, Kaman L, Verma GR, Singh R (2006) Evaluation of the role of prophylactic antibiotics in elective laparoscopic cholecystectomy a prospective randomized trial. Trop Gastroenterol 27(1):54–57PubMed
23.
go back to reference Choudhary A, Bechtold ML, Puli SR, Othman MO, Roy PK (2008) Role of prophylactic antibiotics in laparoscopic cholecystectomy: a meta-analysis. J Gastrointest Surg 12:1847–1853CrossRefPubMed Choudhary A, Bechtold ML, Puli SR, Othman MO, Roy PK (2008) Role of prophylactic antibiotics in laparoscopic cholecystectomy: a meta-analysis. J Gastrointest Surg 12:1847–1853CrossRefPubMed
24.
go back to reference McGuckin M, Shea J, Schwartz JS (1999) Infection and antimicrobial use in laparoscopic cholecystectomy. Infect Control Hosp Epidemiol 20(9):624–626CrossRefPubMed McGuckin M, Shea J, Schwartz JS (1999) Infection and antimicrobial use in laparoscopic cholecystectomy. Infect Control Hosp Epidemiol 20(9):624–626CrossRefPubMed
25.
go back to reference Diez J, Arozamena CJ, Ferraina P, Franci JM, Ferreres A, Lardies JM, Gutierrez VP (1996) Relation between postoperative infections and gallbladder bile leakage during laparoscopic cholecystectomies. Surg Endosc 10(5):529–532CrossRefPubMed Diez J, Arozamena CJ, Ferraina P, Franci JM, Ferreres A, Lardies JM, Gutierrez VP (1996) Relation between postoperative infections and gallbladder bile leakage during laparoscopic cholecystectomies. Surg Endosc 10(5):529–532CrossRefPubMed
26.
go back to reference Al-Awami SM, Al-Breiki H, Abdul-Khader AS, Twum-Danso K, Grant C, Wosornu L (1991) Wound infection following biliary surgery. A prospective study. Int Surg 76:77–80PubMed Al-Awami SM, Al-Breiki H, Abdul-Khader AS, Twum-Danso K, Grant C, Wosornu L (1991) Wound infection following biliary surgery. A prospective study. Int Surg 76:77–80PubMed
27.
go back to reference Gold-Deutch R, Mashiach R, Boldur I, Ferszt M, Negri M, Halperin Z, Lin G, Sackier J, Halevy A (1996) How does infected bile affect the postoperative course of patients undergoing laparoscopic cholecystectomy? Am J Surg 172:272–274CrossRefPubMed Gold-Deutch R, Mashiach R, Boldur I, Ferszt M, Negri M, Halperin Z, Lin G, Sackier J, Halevy A (1996) How does infected bile affect the postoperative course of patients undergoing laparoscopic cholecystectomy? Am J Surg 172:272–274CrossRefPubMed
28.
go back to reference Chuang SC et al (2004) Risks factors for wound infections after cholecystectomy. J Formos Med Assoc 103:607–612PubMed Chuang SC et al (2004) Risks factors for wound infections after cholecystectomy. J Formos Med Assoc 103:607–612PubMed
29.
go back to reference Aga E, Keinan-Boker L, Eithan A, Mais T, Rabinovich A, Nassar F (2015) Surgical site infections after abdominal surgery: incidence and risk factors. A prospective cohort study. Infect Dis (Lond) 47(11):761–767CrossRef Aga E, Keinan-Boker L, Eithan A, Mais T, Rabinovich A, Nassar F (2015) Surgical site infections after abdominal surgery: incidence and risk factors. A prospective cohort study. Infect Dis (Lond) 47(11):761–767CrossRef
30.
go back to reference Koek MB, Wille JC, Isken MR, Voss A, van Benthem BH (2015) Post-discharge surveillance (PDS) for surgical site infections: a good method is more important than a long duration. Euro Surveill 20(8):21042CrossRefPubMed Koek MB, Wille JC, Isken MR, Voss A, van Benthem BH (2015) Post-discharge surveillance (PDS) for surgical site infections: a good method is more important than a long duration. Euro Surveill 20(8):21042CrossRefPubMed
31.
go back to reference Sato N, Shibao K, Mori Y, Higure A, Yamaguchi K (2015) Postoperative complications following single-incision laparoscopic cholecystectomy: a retrospective analysis in 360 consecutive patients. Surg Endosc 29(3):708–713CrossRefPubMed Sato N, Shibao K, Mori Y, Higure A, Yamaguchi K (2015) Postoperative complications following single-incision laparoscopic cholecystectomy: a retrospective analysis in 360 consecutive patients. Surg Endosc 29(3):708–713CrossRefPubMed
Metadata
Title
Effect of bag extraction to prevent wound infection on umbilical port site wound on elective laparoscopic cholecystectomy: a prospective randomised clinical trial
Authors
Jordi Comajuncosas
Judit Hermoso
Jaime Jimeno
Pere Gris
Rolando Orbeal
Antonio Cruz
David Parés
Publication date
01-01-2017
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 1/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-016-4965-z

Other articles of this Issue 1/2017

Surgical Endoscopy 1/2017 Go to the issue