Laparoscopic surgery reduces the incidence of surgical site infections compared to the open approach for colorectal procedures: a meta-analysis

N Kulkarni, T Arulampalam, N Kulkarni, T Arulampalam

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: Colorectal surgery; Enhanced recovery; Laparoscopy; Open surgery; Surgical site infections; Wound infections.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Age of patients
Fig. 3
Fig. 3
Female patients
Fig. 4
Fig. 4
Forest plot of risk ratio for wound infection for laparoscopic versus open colorectal surgery
Fig. 5
Fig. 5
Forest plot of risk ratio for abdominal abscess formation for laparoscopic versus open colorectal surgery
Fig. 6
Fig. 6
Forest plot for surgical site infection combined with wound infection and abscess for laparoscopic versus open colorectal surgery

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Source: PubMed

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