Factors influencing wound infection following laparoscopic cholecystectomy

Although risk factors for wound infection following conventional open cholecystectomy have been extensively studied in the literature, for laparoscopic cholecystectomy (LC) these have not been evaluated thoroughly. We studied factors that influence wound infection following LC. The aim of our study was to evaluate the incidence of wound infection following LC in low-risk patients and the factors that influence its causation. Over a 2-year period, 113 low-risk patients undergoing elective LC for symptomatic gall stone disease were included in this study. Nasal swab and abdominal skin swab cultures were taken one day prior to surgery to detect any aerobic organisms. Intraoperatively, gallbladder bile and a swab from the epigastric port were taken for aerobic and anaerobic culture. Post-operatively, a wound swab was taken from the infected port site (if any) and cultured to detect any aerobic and anaerobic organisms. The duration of preoperative hospital stay, operating time and intraoperative bile spillage were noted for each patient. The patients were evaluated on post-operative days 1, 7, 14 and 30 to look for any evidence of wound infection. Step-wise logistic regression analysis was performed to evaluate the factors influencing the occurrence of wound infection. Wound infection developed in 7/113 patients (6.3%) and was more common in patients who were positive for nasal Staphylococcus aureus (7.3% v. 4.1%, p not statistically significant), bactibilia (12.7% v. 1.5%, p < 0.01) and wound contamination at the time of surgery (13.9% v. 1.3%, p < 0.04). Step-wise logistic regression analysis showed a 13.2 times higher incidence of wound infection in patients who had bactibilia. Bactibilia is the most important predictor of wound infection in low-risk patients undergoing elective LC. As it may not be possible to diagnose which patients have bactibilia by routine investigation, it is advisable to use prophylactic antibiotics to reduce the incidence of wound infection.