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Chronic Laparoscopic Port-Site Infection: A Systematic Review
Muhammad Tahir Ghani1, Ibad Ur Rehman2, Nain Sukh3
1Department of Surgery, Aero Hospital, Rawalpindi, Pakistan.
Summary
Chronic laparoscopic port-site infections (PSIs) are caused by non-tuberculous mycobacteria (NTM), often linked to contaminated reusable instruments. Effective management involves surgical debridement and targeted antimicrobial therapy, with prevention through disposable instruments and proper sterilization.
Area of Science:
- Infectious Diseases
- Surgical Infections
- Microbiology
Background:
- Chronic laparoscopic port-site infections (PSIs) are increasingly recognized.
- Non-tuberculous mycobacteria (NTM) are identified as a common causative agent.
- Contaminated reusable laparoscopic instruments pose a significant risk factor.
Purpose of the Study:
- To systematically review the etiology and management of chronic NTM-related PSIs.
- To consolidate existing literature on NTM PSIs from South Asia.
- To identify effective treatment strategies and preventive measures.
Main Methods:
- Systematic literature search of PubMed, Google Scholar, Cochrane, and PakMediNet.
- Inclusion of ten studies reporting on 109 patients with chronic PSI.
- Analysis of causative agents, treatment outcomes, and identified sources of infection.
Main Results:
- Reusable instruments, chemically sterilized, were implicated in all reviewed studies.
- The primary source of NTM was identified as contaminated rinse water for instruments.
- Effective treatments included surgical debridement/excision and culture-guided antimicrobials (clarithromycin, amikacin, ciprofloxacin, levofloxacin).
- Standard anti-tuberculous treatment (ATT) was used in 11% of cases.
Conclusions:
- Chronic PSIs caused by NTM are associated with the reuse and inadequate sterilization of laparoscopic instruments.
- Surgical intervention combined with appropriate antimicrobial therapy is the most successful management approach.
- Implementing disposable instruments and stringent sterilization protocols is crucial for prevention.
