Reduced wound infection in colorectal resection by using a wound auto-retractor

Surgical site infection (SSI) remains an important problem in colorectal surgery. The aim of this study is to determine whether the use of a wound protection system can be effective in reducing the incidence of wound infection after colorectal resection. Ninety-five consecutive patients underwent colorectal resection, carried out by one single surgeon during a six-year period (2009-2015). A laparotomy auto-retractor was used in all cases (Alexis Wound Retractor; Applied Medical, Rancho Santa Margarita, CA). Forty-two resections (44%) were made by laparoscopy. Anastomoses for laparoscopic right colectomies, section of left colon and insertion of the anvil of CEEA for laparoscopic left colectomies were made extracorporeally. No colon cleansing was used in 67 patients (72%). The median age for those undergoing colectomy was 67 (range 41-90). The median Body Mass Index was 25.04 (range 18- 36.76). Three patients (3%) were operated on an emergency basis because of bowel obstruction or perforation. Fifty-three patients were classified ASA I-II (56%). There were six re-operations, for anastomotic dehiscence, peri-ostomal cellulitis and postoperative bleeding. The median postoperative stay was eight days (range 3-28). Only one patient (1%) developed wound infection. Due to the significantly reduced incidence of postoperative wound infection, this study suggests that the Alexis retractor be considered for routine use.