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How can we control intraoperative bacterial contamination and surgical-site infection during an anterior resection or
Katsunori Nishikawa1, Nobuyoshi Hanyuu, Masami Yuda
1Division of Surgery, Machida Municipal Hospital, 2-15-41 Asahimachi, Machida-shi, Tokyo, 194-0023, Japan. ka2nissy@aol.com
Purpose:
Intraoperative bacterial contamination (IBC) is a major cause of surgical-site infection (SSI). Therefore, we investigated whether the ingenuity of surgical procedures could reduce the incidence of IBC/SSI.
Methods:
Sixty patients who were surgically treated for recto-sigmoid cancer were investigated. Among these patients, the colon was transected during the early perioperative period (ET) in 29 patients and during the late period (LT) in 31 patients. Three samples for IBC were obtained from the irrigation fluid before abdominal closure (LAVAGE), the remaining cut sutures after peritoneal closure (SUTURE), and a subcutaneous swab of the wound (SUBCUT).
Results:
The overall SSI and IBC rates were 25% and 55.2%, respectively. Patients who developed SSI had an extremely high IBC rate (85%), and IBC patients also had a high SSI rate (68%). IBC was highest in the LAVAGE (26%) followed by the SUBCUT (26%), and the SUTURE (12%). The incidence of IBC in the LT was significantly lower than that in the ET (19% vs. 55%, p < 0.01), although the incidence of SSI was similar in both IBC groups.
Conclusion:
Shortening the exposure of the colonic mucosa decreased the incidence of IBC/SSI; thus, careful operations to minimize IBC are recommended.
Insights
Minimizing intraoperative bacterial contamination (IBC) by shortening colonic mucosa exposure during recto-sigmoid cancer surgery significantly reduces infection rates. Careful surgical techniques are crucial for preventing surgical-site infections (SSI).
Area of Science:
- Surgical Oncology
- Infectious Disease Control
- Gastrointestinal Surgery
Background:
- Intraoperative bacterial contamination (IBC) is a primary driver of surgical-site infections (SSI).
- Effective strategies to mitigate IBC during complex procedures like recto-sigmoid cancer surgery are essential.
Purpose of the Study:
- To evaluate if innovative surgical techniques, specifically timing of colonic transection, can reduce IBC and subsequent SSI.
- Investigate the correlation between intraoperative contamination and surgical site infection development.
Main Methods:
- A study involving 60 patients undergoing recto-sigmoid cancer surgery.
- Patients were divided into early (ET) and late (LT) colonic transection groups.
- Bacterial samples were collected from irrigation fluid (LAVAGE), sutures (SUTURE), and wound swabs (SUBCUT).
Main Results:
- Overall SSI and IBC rates were 25% and 55.2%, respectively.
- IBC was significantly lower in the late transection group (19%) compared to the early group (55%, p < 0.01).
- Patients with SSI had a high IBC rate (85%), and IBC patients had a high SSI rate (68%).
Conclusions:
- Reducing the duration of colonic mucosa exposure during surgery effectively decreases IBC and SSI incidence.
- Meticulous surgical practices aimed at minimizing intraoperative contamination are strongly recommended for better patient outcomes.
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