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Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction
Published on: March 24, 2023
Peritoneal contamination and associated post-operative infectious complications after natural orifice specimen
Sheng-Chi Chang1,2, Tsung-Han Lee3, Tao-Wei Ke1
1Division of Colorectal Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan.
Background:
Peritoneal contamination is a major concern during natural orifice specimen extraction after laparoscopic colorectal resection (LCR-NOSE), but few data are available. We explored the prevalence, risk factors, and association between clinical outcomes and infectious complications in patients with positive peritoneal drain fluid culture (PDFC) after LCR-NOSE.
Method:
We retrospectively analyzed patient records in our prospectively maintained registry database who underwent LCR-NOSE between 2011and 2020. Peritoneal drain fluid was collected within 12 h post-operative and cultures for microorganisms were obtained. The relationships between PDFC, clinical variables, and infectious complications were examined by univariate and multivariable analysis.
Results:
Of 241 consecutive patients who underwent LCR-NOSE and drainage fluid culture, 59 (24.5%) had PDFC. Anterior resection (Odds ratio OR 2.40) was identified as an independent predictor for PDFC. Twenty-eight patients (11.6%) developed infectious complications. Multivariable analysis identified low anterior resection (OR 2.74), prolonged operative time (OR 3.20), and PDFC (OR 5.14) as independent risk factors. Pseudomonas aeruginosa was the most frequently found microorganism (OR 5.19) responsible for infectious complications.
Conclusions:
Microorganisms are commonly present in the peritoneum after LCR-NOSE and play a critical role in the development of infectious complications and related morbidity. Specific caution is warranted in patients contaminated with specific types of microorganisms.
Insights
Peritoneal contamination is common after laparoscopic colorectal resection with natural orifice specimen extraction (LCR-NOSE). Positive drain fluid cultures increase infectious complication risk, particularly with Pseudomonas aeruginosa.
Area of Science:
- Colorectal Surgery
- Minimally Invasive Surgery
- Infectious Disease
Background:
- Peritoneal contamination is a significant concern in laparoscopic colorectal resection with natural orifice specimen extraction (LCR-NOSE).
- Limited data exist on the prevalence, risk factors, and clinical impact of positive peritoneal drain fluid cultures (PDFC) following LCR-NOSE.
Purpose of the Study:
- To investigate the prevalence of PDFC after LCR-NOSE.
- To identify risk factors associated with PDFC.
- To determine the relationship between PDFC and infectious complications.
Main Methods:
- Retrospective analysis of 241 patients undergoing LCR-NOSE (2011-2020).
- Collection and culture of peritoneal drain fluid within 12 hours post-operatively.
- Univariate and multivariable analyses to assess relationships between PDFC, clinical variables, and infectious complications.
Main Results:
- 59% (24.5%) of patients had PDFC.
- Anterior resection was an independent predictor for PDFC (OR 2.40).
- Infectious complications occurred in 11.6% of patients. Low anterior resection, prolonged operative time, and PDFC were independent risk factors for complications (ORs 2.74, 3.20, 5.14 respectively).
- Pseudomonas aeruginosa was the most common pathogen (OR 5.19).
Conclusions:
- Microorganisms are frequently present in the peritoneum post-LCR-NOSE.
- PDFC is a critical factor in developing infectious complications and associated morbidity.
- Vigilance is necessary for patients with specific microbial contamination.
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