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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.
Abstract:
Chronic laparoscopic port-site infection (PSI) is caused by non-tuberculous mycobacteria (NTM). This systematic review aimed to gather all existing information about the aetiology and management of chronic PSI. A systematic search of PubMed, Google Scholar, Cochrane, and PakMediNet databases was carried out. Ten studies were selected; eight from India and two from Pakistan. A total of 109 patients were reported to have chronic PSI. In all studies, reusable laparoscopic instruments were used, which were chemically sterilised. Clarithromycin, amikacin, ciprofloxacin, and levofloxacin were reported as the most sensitive medicines when used for a duration of three months. Additionally, 11% of cases were treated with standard first-line anti-tuberculous treatment (ATT). NTM was cultured successfully in 52% of patients. Histological examination of the excised tracts showed chronic granulomatous inflammation. The source of NTM was identified as the water used to rinse reusable instruments. Debridement or excision of infected tracts, followed by antimicrobial agents according to culture, was the most successful treatment. The use of disposable laparoscopic instruments and standard sterilisation measures can help prevent these infections. Key Words: Port-site infections, Non-tuberculous mycobacteria, Anti-tuberculous treatment.
Insights
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.
