Prolonged Umbilical Port Insertion Time Increases the Incidence of Umbilical Surgical Site Infection in Laparoscopic...

Area of Science:

• Pediatric Surgery
• Surgical Site Infections
• Minimally Invasive Surgery

Background:

• Umbilical surgical site infection (U-SSI) is the most frequent complication of laparoscopic percutaneous extraperitoneal closure (LPEC) for pediatric inguinal hernias.
• While prolonged operative time is a known risk factor for surgical site infections (SSI) in general pediatric surgery, its specific association with post-LPEC U-SSI remains unclear.

Purpose of the Study:

• To investigate the relationship between umbilical port insertion time and the incidence of U-SSI in children undergoing LPEC for inguinal hernia repair.
• To identify a potential threshold for umbilical port insertion time associated with an increased risk of U-SSI.

Main Methods:

• Retrospective analysis of 232 pediatric patients (<16 years) who underwent LPEC for inguinal hernia between June 2018 and May 2023.
• Exclusion of patients who had umbilical hernia repair or other procedures.
• Receiver operating characteristic (ROC) analysis to determine the cutoff value for umbilical port insertion time (identified as 8 minutes) and comparison of U-SSI incidence between groups with short (<8 minutes) and long (≥8 minutes) insertion times.

Main Results:

• Seven out of 232 patients (3.0%) developed superficial incisional post-LPEC U-SSI.
• The incidence of U-SSI was significantly higher in the group with prolonged umbilical port insertion time (≥8 minutes) at 20.0%, compared to 2.3% in the group with shorter insertion times (<8 minutes) (P = .03).

Conclusions:

• Prolonged umbilical port insertion time (≥8 minutes) is associated with an increased incidence of post-LPEC U-SSI in children undergoing inguinal hernia repair.
• Minimizing umbilical port insertion time may be a strategy to reduce the risk of U-SSI in this patient population.