Applying vacuum to accomplish reduced wound infections in laparoscopic pediatric surgery
Robin Visser1, Kris Milbrandt2, Suyin Lum Min2
1Department of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
Insights
Negative pressure wound therapy did not significantly reduce surgical site infections in pediatric laparoscopic surgery. This randomized controlled trial found similar infection rates between vacuum dressings and standard dressings for umbilical port sites.
Area of Science:
- Pediatric Surgery
- Infectious Disease Prevention
- Minimally Invasive Surgery
Background:
- Surgical site infections (SSIs) are a concern in pediatric surgery, with limited research on prevention strategies.
- Negative pressure wound therapy (NPWT) is effective for complex wounds, but its application in reducing SSIs after laparoscopic surgery is unexplored.
- This study investigates the potential of NPWT principles to decrease wound infection rates in pediatric laparoscopic procedures.
Purpose of the Study:
- To evaluate the efficacy of vacuum dressings compared to standard dressings in preventing surgical site infections at the umbilical port site in pediatric patients undergoing laparoscopic surgery.
- To test the hypothesis that NPWT can reduce wound infection rates following laparoscopic surgery.
Main Methods:
- A randomized controlled trial was conducted involving pediatric patients with an umbilical port site.
- Patients were randomized to receive either a standard dressing or a vacuum dressing, with dressings removed 48 hours post-surgery.
- Wound infections were assessed by a blinded nurse between postoperative days 7-10, with data analyzed using Fisher's exact test.
Main Results:
- The study randomized 44 patients to the vacuum dressing group and 42 to the control group.
- The infection rate in the vacuum dressing group was 2.8% (1/35), and in the control group was 3.3% (1/30).
- No significant difference in infection rates was observed between the two groups (p=1.0).
Conclusions:
- The study was terminated early due to an interim analysis indicating a need for an impractically large sample size to achieve statistical power.
- There was no significant difference found in the reduction of post-operative wound infections between vacuum dressings and standard dressings.
- The findings suggest that vacuum dressings may not be superior to standard dressings for preventing umbilical port site infections in pediatric laparoscopic surgery.
Introduction:
The prevention of surgical site infections has received little attention in pediatric surgery. Negative pressure wound therapy is used to treat complex wounds. We hypothesized that this principle could reduce wound infection rates following laparoscopic surgery. We tested this in a randomized controlled trial.
Materials And Methods:
We randomized pediatric patients with an umbilical port site to a standard dressing or a vacuum dressing. The dressings were removed 48h after surgery. A nurse blinded for the treatment inspected the umbilical wound between post-operative days 7-10 for infection. Data comparison was performed using a Fisher exact test with p<0.05 defined as significant.
Results:
We recruited 90 patients over 2 years and randomized 44 to the vacuum dressing arm and 42 to the control arm. We observed a 2.8% (n=1/35) infection rate in the vacuum dressing group and 3.3% (n=1/30) in the control group (p=1.0).
Discussion:
We ended our study early when an interim analysis showed an impractical number of patients would be required to achieve sufficient power. We did not find a significant difference between the control and vacuum dressings in reducing post-operative wound infections.
Level Of Evidence:
3.
