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

Abstract Introduction Approximately 8% of patients who undergo laparoscopic surgery develop port site infections1. This would negatively impact recovery and increase rates of readmission. Patients’ skin is a major source of pathogens that results in surgical site infection (SSI). Therefore, optimisation of antiseptic skin preparations may decrease postoperative umbilical port site infection (UPSI). Method A retrospective analysis of 226 cases from August 2019 till October 2020 at East Lancashire Hospital NHS Trust was performed. The first cycle included 122 patients (58 cholecystectomies and 64 appendicectomies), and a further 104 patients (51 cholecystectomies and 53 appendicectomies) after emphasising on using chlorhexidine pink as skin preparation. The presence of UPSIs within 30 days post-surgery was recorded. Results In the first cycle, the local preparation that was used in patients with UPSI was chlorhexidine pink (21.4%) and betadine (78.6%). The surgical team were then educated regarding the benefits of chlorhexidine pink over betadine as local skin preparation. In the second cycle, 63.3% used chlorhexidine pink and 36.7% used betadine. After the above implementation, there was a reduction in the rate of UPSI (18.0% to 15.7%) and readmission rates (7.2% to 5.9%) in patients who had undergone laparoscopic cholecystectomy. In patients who had undergone laparoscopic appendicectomy, a similar trend in UPSI rates was identified as well (7.1% to 5.5%) and readmission rates (5.5% to 1.9%). Conclusions The incidence of UPSI was reduced with the use of chlorhexidine pink compared to betadine. This may have contributed to the decrease in UPSI cases and led to a reduction in re-admission rates.

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Port site complications following laparoscopic surgeries: a prospective study

International Surgery Journal ◽

10.18203/2349-2902.isj20180360 ◽

2018 ◽

Vol 5 (2) ◽

pp. 598

Author(s):

Madan Mohan Mudgal ◽

Pradeep Kumar Kothiya ◽

Naveen Kushwah ◽

Raghvendra Singh

Keyword(s):

Laparoscopic Surgery ◽

Hypertrophic Scar ◽

Minimal Invasive Surgery ◽

Minimal Invasive ◽

Port Site ◽

Age Group ◽

Site Infection ◽

Visceral Injury ◽

Verres Needle ◽

A Prospective Study

Background: Port site complications are bothersome complications which undermine the benefits of minimal invasive surgery, not only does it add to the morbidity of the patient but also spoil the reputation of the surgeon. Aims and objective of the study was to determine the morbidity associated with the port site complications in laparoscopic surgery and to identify risk factors for complications.Methods: Three hundred patients having age between 15-50 years admitted for elective laparoscopic procedure were studied. All the patients had preoperative workup and general anaesthesia was given with endotracheal intubation. The patients were observed for any port-site complication during operation and in the immediate and postoperative till three months.Results: Female preponderance (77.34%) was observed with maximum patients belonging to age group of 41-50 years (31.7%). Majority of the patients were in the BMI range of 18.5-25kg/m2 (53.33%). In 54.66% and45.33% patients Verres needle and Hasson’s (Open) method was used to create pneumoperitoneum. Cholecystectomy was the indication in 80% patients. Port site morbidity was observed in 8.67% patients. As an early port site complication, bleeding, surgical site infection, emphysema and visceral injury was observed in 6, 8, 4 and 1 patient respectively. As a late port site complication, 4 and 3 patients developed hernia and hypertrophic scar respectively.Conclusions: Port site complications are least in elective laparoscopic surgery.

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Assessment of Port Site Complications in Laparoscopic Surgery – A Prospective Descriptive Study from Western Odisha

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/394 ◽

2021 ◽

Vol 8 (24) ◽

pp. 2106-2111

Author(s):

Harekrishna Majhi ◽

Tapan Kumar Nayak ◽

Sheik Salman Raghib ◽

Anand Seba Tirkey

Keyword(s):

Laparoscopic Surgery ◽

Recovery Period ◽

Gastrointestinal Surgery ◽

Surgical Care ◽

Descriptive Study ◽

Port Site ◽

P Value ◽

Site Infection ◽

Port Site Hernia ◽

Antibiotics Use

BACKGROUND Laparoscopic surgery has brought about a paradigm shift in modern surgical care. It has varied applications in gastrointestinal surgery, urological surgery, gynaecological surgery and oncosurgery. Better cosmesis, less post-operative pain, hence reduced need for post-operative analgesia, shorter recovery period and faster return to daily activities are its advantages. However, certain complications like port site infection, hemorrhage, hernia, TB or metastasis are morbid complications that undermine its benefits. In this study, we wanted to identify the various port site complications in patients undergoing laparoscopic surgery for different diseases in our hospital and assess its incidence. METHODS This is a prospective descriptive study. 125 patients admitted to the Department of General Surgery from November 2018 to October 2020 who fulfilled the inclusion and exclusion criteria underwent elective laparoscopic surgeries. They were observed post-operatively for various port site complications. All the data was entered into the Microsoft Excel 2007 software and further analysis was done using SPSS software version 24.0 (IBM Inc. Chicago). A P - value of less than 0.05 was considered statistically significant. RESULTS Of 125 patients that underwent laparoscopic surgery, 9 patients (7.2 %) developed complications specific to port site upon a follow-up of 3 months. Complications observed were port site infection (n = 4, 3.2 %), port site hemorrhage (n = 2, 1.6 %). Port site hernia, port site tuberculosis (TB), umblical port site hernia and mild subcutaneous emphysema were observed in one patient each (0.8 %). Scar abnormalitites were seen in 3 patients (2.4 %). CONCLUSIONS Laparoscopy is associated with minimal complications. However rare these complications are, they take away from the advantages of the laparoscopic surgery and the reputation of the hospital and surgeon alike. Apt patient selection, meticulous surgical technique, proper sterilization of the laparoscopic instruments and effective antibiotics use can further reduce the incidence of complications. KEYWORDS Laparoscopy, Port Site Complications, Infection, Hernia, Hemorrhage

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Port-site infection due to nontuberculous mycobacteria following laparoscopic surgery

International Journal of Mycobacteriology ◽

10.4103/ijmy.ijmy_32_20 ◽

2020 ◽

Vol 9 (3) ◽

pp. 231

Author(s):

WaniganeththiArachchige Manori Piyumal Samaranayake ◽

AlisonMargaret Kesson ◽

JonathanSaul Karpelowsky ◽

AlexanderConrad Outhred ◽

BenJacobus Marais

Keyword(s):

Laparoscopic Surgery ◽

Nontuberculous Mycobacteria ◽

Port Site ◽

Site Infection

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Protracted Port-site Infection: A Dilemma

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1198 ◽

2012 ◽

Vol 4 (3) ◽

pp. 144-146

Author(s):

Partha Mukhopadhyay ◽

Sebanti Goswami ◽

Nandini Kapoor

Keyword(s):

Laparoscopic Surgery ◽

Port Site ◽

Causative Organism ◽

Site Infection ◽

Prospective Longitudinal Study ◽

Atypical Mycobacterium ◽

E Coli ◽

Aerobic Culture ◽

Mycobacterium Infection ◽

Prospective Longitudinal

ABSTRACT Objectives From simple beginnings, laparoscopic surgery has now been completely integrated into the field of gynecological surgery. Infection of the port site is an infrequent complication of laparoscopy. The causative organisms of this infection are usually those which are most prevalent in the institute, e.g. S.aureus, E.coli. These types of infections are easily treated by the antibiotics which are most commonly prescribed in the institute. Sometimes, these port-site infections become protracted and recurrent and pose as a dilemma for the surgeons and become distressing for the patients. Materials and methods A prospective longitudinal study was conducted on 25 patients presenting to the OPD with recurrent discharge or nonhealing port-site wound following laparoscopic surgery done in our institute. These patients underwent a battery of test including detailed microbiological examination. The discharge from their port site was sent for routine aerobic culture and sensitivity. It was also sent for Z-N stain and culture for Mycobacterium including atypical Mycobacterium. Results Out of the 25 patients studied, 16 showed presence of AFB bacilli in their discharge and the culture for Mycobacterium showed presence of Atypical Mycobacterium in 12 cases. Out of the remaining nine patients, six showed a growth of S. aureus on aerobic culture and the remaining patients had a growth of E. coli. Conclusion Atypical Mycobacterium is the most common causative organism of recurrent port-site infection in our institute. This type of infection then require a full course of antituberculous drugs for complete eradication. So, when treating a case of nonhealing or recurrent port-site infection, atypical Mycobacterium infection should be kept in mind. How to cite this article Goswami S, Kapoor N, Mukhopadhyay P. Protracted Port-site Infection: A Dilemma. J South Asian Feder Obst Gynae 2012;4(3):144-146.

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PORT-SITE METASTASES AFTER LAPAROSCOPIC SURGERY FOR GYNAECOLOGICAL MALIGNANCIES IN A SOUTHEAST ASIAN POPULATION

10.26226/morressier.5770e29dd462b80290b4c428 ◽

2016 ◽

Author(s):

Alexander Chuang

Keyword(s):

Laparoscopic Surgery ◽

Asian Population ◽

Southeast Asian ◽

Port Site ◽

Southeast Asian Population ◽

Port Site Metastases ◽

Gynaecological Malignancies

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C14 Incidence of local and port site recurrence after laparoscopic surgery for renal cell carcinoma

European Urology Supplements ◽

10.1016/s1569-9056(13)61862-x ◽

2013 ◽

Vol 12 (4) ◽

pp. e1122, C14

Author(s):

D. Rojo García ◽

A. Prera ◽

C. Abad ◽

J. Muñoz ◽

R. Martos ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Laparoscopic Surgery ◽

Cell Carcinoma ◽

Renal Cell ◽

Port Site ◽

Port Site Recurrence

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Frequency of port site infection following gall bladder removal through Epigastric vs Umbilical port.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.03.6309 ◽

2021 ◽

Vol 28 (03) ◽

pp. 277-281

Author(s):

Bushra Shaikh ◽

Imamuddin Baloch ◽

Azhar Ali Shah ◽

Abdul Sami Mirani ◽

Parkash Lal Lund ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Gall Bladder ◽

Wound Infection ◽

Port Site ◽

Site Infection ◽

College Hospital ◽

Medical College ◽

Duration Of Surgery ◽

Group A ◽

Group B

Objective: To compare the frequency of port site wound infection following gall bladder removal through umbilical and epigastric port in laparoscopic cholecystectomy. Study Design: Randomized Control Trial. Setting: Surgical Unit 2, Ghulam Muhammad Mahar Medical College, hospital Sukkur. Period: 1st November 2019 to 30th October 2020. Material & Methods: All cases who underwent four port laparoscopic cholecystectomy were enrolled in two groups. All procedures were performed under general anesthesia. As the last event of surgery gall bladder was retrieved in a glove bag through umbilical port in group A and through epigastric port in group B, both under direct camera vision. Wound infection was considered if there was 3 to 5 grade of wound according to Southampton wound grading system (Figure-1) on 5th postoperative day. All demographics and outcome variables were recorded. Results: Age ranged from 20 to 60 years with mean age of 38.875±8.11 years, BMI 29.973±5.12 Kg/m2, duration of surgery 50.656±8.41 mins and Southampton score was 1.044±1.07 in Group A and mean age of 38.560±6.23 years, BMI 27.437±5.04 Kg/m2, duration of surgery 48.920±8.67 mins and Southampton score was 0.856±0.92 in Group B. In group A, 18 (5.7%)patients developed port site wound infection in contrast to 5 (1.6%) patients in group B (P= 0.006). Conclusion: We conclude that epigastric port retrieval of gall bladder following laparoscopic cholecystectomy results in less port site infection.

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