What lies beneath: unveiling the umbilical bacterial flora in pediatric laparoscopic surgery

The umbilicus is a common entry point for laparoscopic surgery but is prone to bacterial colonization, increasing the risk of surgical site infections (SSIs). This study aimed to characterize the umbilical and abdominal skin microflora in pediatric patients undergoing laparoscopic surgery and identify factors influencing bacterial colonization. This study analyzed 100 pediatric patients (0-18 years) who underwent laparoscopic surgery at Samsung Medical Center from January 2020 to December 2021. Skin swabs from the umbilicus and right upper quadrant (RUQ) were collected before and after antiseptic preparation with alcohol-chlorhexidine solution. Bacterial species and resistance profiles were identified, and perioperative factors were analyzed for associations with colonization. Before antiseptic preparation, bacterial colonization was observed in 84% of umbilical samples and 23% of RUQ samples, with Staphylococcus epidermidis being the most common isolate. After preparation, bacterial growth was eliminated in 99% of cases. Patients with indwelling catheters (p < 0.001, OR 55.69), stomas (p < 0.001, OR 55.69), and recent antibiotic use (p = 0.022, OR 3.28) had significantly higher rates of RUQ colonization. Antibiotic use at surgery further increased RUQ colonization risk (p = 0.040, OR 4.35). No significant associations were found with age, gender, or immunosuppression. Notably, no postoperative SSIs were reported, underscoring the effectiveness of antiseptic preparation. The umbilicus demonstrated a higher rate of bacterial colonization compared to RUQ skin in pediatric patients undergoing laparoscopic surgery. Nonetheless, proper antiseptic techniques ensured over 99% of cases were free from bacterial growth, affirming the safety of the umbilicus as a primary entry port for minimally invasive procedures. Factors such as indwelling catheters, stomas, and recent antibiotic use were linked to increased bacterial colonization at RUQ sites, emphasizing the importance of tailored prophylactic antibiotics and meticulous antiseptic preparation in these patients.