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Port-site tuberculosis after laparoscopy: report of eight cases
1Department of Gastrointestinal Surgery, PVS Memorial Hospital, 31/543, Subhash Nagar, Edappally, Cochin 682024, Kerala, India. hramesh@vsnl.com
Abstract:
In light of the explosive increase in laparoscopic surgery, there is concern about the effectiveness of sterilizing reusable laparoscopic instruments by immersion in 2% glutaraldehyde. This article describes the clinical features of eight patients who presented with biopsy-proven tuberculosis at the port-site unassociated with other clinical features of tuberculosis. Three of the eight patients had positive cultures for Mycobacterium tuberculosis. The port-site sinuses healed with antituberculous chemotherapy. There is conflicting information in the literature regarding the effectiveness of a 20-min instrument soak in 2% glutaraldehyde to clear M. tuberculosis. In light of the preceding information, the current practice of glutaraldehyde disinfection for reusable laparoscopes needs to be reexamined.
Insights
Laparoscopic surgery instruments may not be effectively sterilized by glutaraldehyde immersion, as evidenced by port-site tuberculosis cases. This highlights the need to re-evaluate current disinfection practices for reusable surgical tools.
Area of Science:
- Infectious Diseases
- Surgical Innovation
- Microbiology
Background:
- Laparoscopic surgery's rise necessitates effective sterilization of reusable instruments.
- Glutaraldehyde immersion is a common disinfection method.
- Concerns exist regarding glutaraldehyde's efficacy against certain pathogens like Mycobacterium tuberculosis.
Observation:
- Eight patients developed biopsy-proven tuberculosis at surgical port sites, unrelated to other TB symptoms.
- Three of these patients had positive Mycobacterium tuberculosis cultures.
- Port-site sinuses resolved with antituberculous chemotherapy.
Findings:
- Conflicting data exists on the effectiveness of a 20-minute glutaraldehyde soak for eliminating Mycobacterium tuberculosis.
- This case series suggests potential failures in glutaraldehyde disinfection for reusable laparoscopic instruments.
- Mycobacterium tuberculosis transmission via surgical instruments is a plausible concern.
Implications:
- Current glutaraldehyde disinfection protocols for reusable laparoscopic instruments require critical re-examination.
- Alternative or supplementary sterilization methods may be necessary to ensure patient safety.
- Further research is crucial to establish definitive sterilization guidelines for laparoscopic instruments.