Laparoscopic surgery reduces the incidence of surgical site infections compared to the open approach for colorectal proc
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REVIEW
Laparoscopic surgery reduces the incidence of surgical site infections compared to the open approach for colorectal procedures: a meta‑analysis N. Kulkarni1,3 · T. Arulampalam2,3 Received: 8 March 2020 / Accepted: 5 July 2020 © Springer Nature Switzerland AG 2020
Abstract Background Surgical site infections (SSI) are the commonest healthcare associated infections. They severely compromise patient safety, are a significant burden on healthcare resources and have an adverse impact on patient quality of life. The incidence of SSIs can be as high as 10% after colorectal procedures. The laparoscopic approach is being increasingly used to undertake colorectal procedures. It provides advantages over the traditional open approach with smaller incisions, shorter hospital stay and equal oncological outcomes. The aim of this meta-analysis was to evaluate whether the laparoscopic approach for colorectal procedures reduces the incidence of SSI compared to the open approach. Methods Randomised controlled trials (RCTs) comparing the two approaches published since 2000 were included in the review. Revman 5.3 software was used to carry out the review. Data were pooled and the results were shown as risk ratios with 95% confidence intervals using the fixed effects model. Results Sixteen RCT’s were included in the analysis comprising 5797 patients. These covered a range of colorectal pathologies including colon cancer, rectal cancer, inflammatory bowel disease and familial adenomatous polyposis syndrome. Analysis showed significantly lower wound infection rates (RR: 0.72, 95% confidence interval: 0.60–0.88, p = 0.001) and lower abdominal abscess rates (RR: 0.88, 95% CI 0.62–1.27, p = 0.51). The combined SSI rate was significantly lower in laparoscopic compared to open surgery (RR: 0.76, 95% CI 0.64–0.90, p = 0.001). Conclusions Laparoscopic colorectal surgery significantly lowers the incidence of SSI compared to open surgery. Keywords Laparoscopy · Open surgery · Surgical site infections · Wound infections · Colorectal surgery · Enhanced recovery
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10151-020-02293-8) contains supplementary material, which is available to authorized users. * N. Kulkarni [email protected] 1
Department of Surgery, United Lincolnshire Hospitals NHS Trust, Lincoln, UK
2
Department of Surgery, East Suffolk and North Essex NHS Trust, Colchester, UK
3
Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
Surgical site infections (SSI) are the commonest healthcare associated infections (HCAI). They severely compromise patient safety, are a significant burden on healthcare resources and have an adverse impact on patient quality of life. The incidence of SSI’s can be as high as 10% after colorectal procedures [1]. The first series of laparoscopic colorectal surgery was reported in 1991 [2]. Numerous multicentre randomised controlled trials (RCTs) carried out internationally have now establi
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