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Laparoscopic Adjustable Gastric Band Colonization May Indicate Re-classification of Surgical Wounds
Zach Ichter1, Habib Khoury2, Lindsey Voller2
1Lancaster General Hospital, Lancaster, PA, USA.
Background:
Surgical wounds are classified as either clean, clean-contaminated, contaminated, or dirty wounds. Historically laparoscopic adjustable gastric band (LAGB) removals have been classified as clean wounds since there is thought to be no existing infection and no transection of the gastrointestinal tract. Surgical site infection (SSI) remains a publicly reported source of morbidity after laparoscopic bariatric surgery and is considered a CMS hospital-acquired condition. We present a retrospective chart review to reveal the rate of bacterial colonization of gastric bands.
Methods:
This retrospective chart review included 15 patients who underwent removal of LAGB. The entire LAGB and port were removed and then sent for aerobic and anaerobic cultures. Patients were followed up to 1 month, and the incidence of surgical site infection development was recorded.
Results:
Of the fifteen LAGBs cultured, eight cases (53%) returned positive for bacterial growth. Five of the cultures (33%) were positive for coagulase-negative Staphylococcus. One culture was positive for micrococcus species (6.7%), one culture was positive for Bacteroides fragilis (6.7%) and another was positive for Propionibacterium (6.7%). None of the 15 patients followed in the study developed an SSI by the end of 1 month.
Conclusions:
Given the consideration of LAGB removals as clean wounds, the incidence of LAGB colonization is high. Classification of the surgical wounds in LAGB removals should be changed from clean to contaminated. Further studies need to be pursued to determine the correlation between colonized LAGBs and the rate of SSIs.
Key Points:
• Gastric band removals are a common bariatric procedure. • Surgical site infection remains an outcome of interest to patient, surgeon and payor. • Fifty-three percent of recovered bands were positive for bacterial growth.
Insights
Bacterial colonization of gastric bands is common during removal, with 53% of bands showing growth. This suggests gastric band removals should be reclassified from clean to contaminated wounds to improve patient safety.
Area of Science:
- Bariatric Surgery
- Surgical Site Infections
- Microbiology
Background:
- Laparoscopic adjustable gastric band (LAGB) removals are typically classified as clean surgical wounds.
- Surgical site infection (SSI) is a significant cause of morbidity after bariatric surgery.
- This study investigates bacterial colonization rates of explanted LAGBs.
Purpose of the Study:
- To determine the rate of bacterial colonization on explanted laparoscopic adjustable gastric bands (LAGBs).
- To evaluate the current wound classification for LAGB removal procedures.
- To inform potential changes in surgical site infection prevention strategies.
Main Methods:
- A retrospective chart review of 15 patients undergoing LAGB removal.
- Explanted LAGBs and ports were cultured for aerobic and anaerobic bacteria.
- Patients were monitored for SSI development for up to 1 month post-surgery.
Main Results:
- Bacterial growth was detected in 53% (8/15) of the cultured gastric bands.
- Coagulase-negative Staphylococcus was the most frequent isolate (33%).
- No surgical site infections (SSIs) were observed in the 15 patients within the 1-month follow-up period.
Conclusions:
- The high incidence of bacterial colonization challenges the 'clean' wound classification for LAGB removals.
- Reclassifying LAGB removals as 'contaminated' wounds may be warranted.
- Further research is needed to establish a definitive link between colonized LAGBs and SSI rates.
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