Frequency And Risk Factor Assessment Of Port-Site Infection After Elective Laparoscopic Cholecystectomy In Low-Risk Patients At A Tertiary Care Hospital Of Kashmir.

摘要

Background and objectives: The study was conducted with the aim to determine frequency and to assess the risk factors of port-site infection after elective laparoscopic cholecystectomy in low-risk patients at a tertiary care hospital of Kashmir.Design and Setting: Prospective.Patients and Methods : The study included 675 consecutive patients of port-site infection after elective laparoscopic cholecystectomy for symptomatic cholelithiasis over a period of 12 months. Culture swabs were taken from port sites of all patients with signs of port site infection and transported to the microbiology laboratory. The positive swab cultures were noted. The risk factors like iatrogenic gallbladder perforation, two port method, experience of surgeon and age of the patients were assessed. The data obtained was analyzed by using appropriate statistical analytical tests. Results: The incidence of port-site infection after elective laparoscopic cholecystectomy is 6.7%. The port site infection is more often superficial and at the epigastric port site, associated with iatrogenic gallbladder perforation and more likely when laparoscopic cholecystectomy is performed by a junior surgeon and by two port method. Conclusion: The primary risk factor for port-site infection after elective laparoscopic cholecystectomy in otherwise normal patients is iatrogenic gallbladder perforation leading to spillage of bile. Introduction Surgical procedures often lead to both intrinsic and extrinsic infections. The human body enables survival of a wide variety of microorganisms with potential for causing infection. In circumstances where systemic host resistance is lowered, such as immuno-suppression from medication and disruption of intact cutaneous or mucous membranes as a result of surgical procedures or trauma, patients’ bacterial flora may become opportunistic and cause infection. Laparoscopic cholecystectomy has become the preferred method of performing gallbladder surgery in present era. Laparoscopic cholecystectomies are associated with shorter hospital stay and convalescence, less pain and scarring, and lower rates of postoperative surgical site infection (SSI) than open cholecystectomies.1-4 The fact that laparoscopic cholecystectomies are associated with fewer surgical site infections (SSIs) intuitively makes sense as laparoscopy access ports are short in length and only a fraction of the length of the incision used in open laparotomy. Elective laparoscopic cholecystectomy has a low risk for infection1-5, but many surgeons still use prophylactic antibiotics. The Centers for Disease Control and Prevention classification (CDC) categorized surgical site infection into incision-site infection and organ-space infection. The incision-site infection is further subdivided into “superficial” in which only skin and subcutaneous tissue is infected and “deep” where fascia and muscles are infected.5, 6 This study was designed to determine the port (incision) site infection rate and assessment of the risk factors for port-site infection in low-risk patients undergoing elective laparoscopic cholecystectomy. Patients and Methods The study included 675 consecutive patients of postoperative port-site infection after elective laparoscopic cholecystectomy for symptomatic cholelithiasis in surgical units of our hospital over a period of 12 months from 1 st April 2010 to 31st March 2011 in the Department of Surgery Government Medical College Srinagar. In order to minimize the bias in our observations, the following patients were excluded: 1) patients with chronic debilitating illnesses and with known malignancies as their chances of port-site infection are higher because of their immunocompromised state, 2) patients in extremes of age because the chance of infection in them is higher, 3) patients with acute cholecystitis as it increases the chance of infection, 4) patients with antibiotic prophylaxis because antibiotics decrease the chance of infection, and 5) patients with port-