Skip to main content
SpringerLink
Log in

Transumbilical abdominal incision for laparoscopic colorectal surgery does not increase the risk of postoperative surgical site infection

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Besides antibiotic prophylaxis, antiseptic skin preparation is an important measure to prevent surgical site infection (SSI). No reports have detailed the relationship between SSI and umbilical microflora following laparoscopic colorectal cancer with a transumbilical longitudinal incision.

Methods

Risk factors and the rate of SSI were investigated in 453 patients who underwent laparoscopic colorectal resection over a 3-year period. Microbiological samples were collected from the umbilicus and SSI areas.

Results

After laparoscopic procedure, we observed SSIs in approximately 5% of cases, with superficial SSI in 15 (3.3%) patients and organ/space SSIs 7 (1.5%). In univariate analysis, preoperative albumin (Alb) value and anastomosis of enterocolostomy were significantly associated with superficial SSI development. Also, age, blood loss, stoma, tumor site (rectum), and Hartmann/abdominal perineal resection (APR) were significant risk factors for organ/space SSI. In multivariate analysis, the preoperative Alb value was the most significant factor associated with a predisposition to superficial SSI. The bacteria detected in SSI were mostly different from those at wound closure. Antibiotic-resistant bacteria were included in organ/space SSI all cases.

Conclusions

SSI development with laparoscopic surgery reportedly occurs in about 3–15% cases. The SSI rate in this study and other reports was comparable. Using small transumbilical longitudinal incision in laparoscopic colorectal surgery is less likely to cause SSI when sufficient control measures are enacted, even though the umbilicus contains resident bacteria in abundance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Watanabe T, Itabashi M, Shimada Y et al (2015) Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines 2014 for treatment of colorectal cancer. Int J Clin Oncol 20:207–239. doi:10.1007/s10147-015-0801-z

    Article  PubMed  PubMed Central  Google Scholar 

  2. Howard DP, Datta G, Cunnick G et al (2010) Surgical site infection rate is lower in laparoscopic than open colorectal surgery. Color Dis 12:423–427

    Article  CAS  Google Scholar 

  3. Poon JT, Law WL, Wong IW et al (2009) Impact of laparoscopic colorectal resection on surgical site infection. Ann Surg 49:77–81

    Article  Google Scholar 

  4. Kiran RP, El-Gazzaz GH, Vogel JD et al (2010) Laparoscopic approach significantly reduces surgical site infections after colorectal surgery: data from national surgical quality improvement program. J Am Coll Surg 211:232–238

    Article  PubMed  Google Scholar 

  5. Mangram AJ, Horan TC, Pearson ML et al (1999) Guideline for prevention of surgical site infection, 1999. U.S. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 27:97–132

    Article  CAS  PubMed  Google Scholar 

  6. Yamamoto S, Fujita S, Akasu T et al (2007) Wound infection after elective laparoscopic surgery for colorectal carcinoma. Surg Endosc 21:2248–2252

    Article  PubMed  Google Scholar 

  7. Kennedy GD, Heise C, Rajamanickam V et al (2009) Laparoscopy decreases postoperative complication rates after abdominal colectomy: results from the National Surgical Quality Improvement Program. Ann Surg 249:596–601

    Article  PubMed  Google Scholar 

  8. Chang SK, Lomanto D, Mayasari M (2012) Single-port laparoscopic spleen preserving distal pancreatectomy. Minim Invasive Surg 2012:197429. doi:10.1155/2012/197429

    PubMed  PubMed Central  Google Scholar 

  9. Delgado S, Ibarzabal A, Adelsdorfer C et al (2012) Transumbilical single-port sleeve gastrectomy: initial experience and comparative study. Surg Endsc 26:1247–1253

    Article  Google Scholar 

  10. Desai MM, Stein R, Rao P et al (2009) Embryonic natural orifice transumbilical endoscopic surgery (E-NOTES) for advanced reconstruction: initial experience. Urology 73:182–187

    Article  PubMed  Google Scholar 

  11. Kleeff J, Erkan M, Jager C et al (2015) Umbilical microflora, antiseptic skin preparation and surgical site infection in abdominal surgery. Surg Infect 16:450–454

    Article  Google Scholar 

  12. Hulcr J, Latimer AM, Henley JB et al (2012) A jungle in there: bacteria in belly buttons are highly diverse, but predictable. PLoS One 7:e47712. doi:10.1371/journal.pone.0047712

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Paes TR, Stoker DL, Ng T et al (1987) Circumumbilical versus transumbilical abdominal incision. Br J Surg 74:822–823

    Article  CAS  PubMed  Google Scholar 

  14. Sharples A, McArthur D, McNamara K, Lengyel J (2011) Back to basics—cutting the cord on umbilical infections. Ann R Coll Surg Engl 93:120–122

    Article  PubMed  Google Scholar 

  15. Enad JG (1963) Midline abdominal transumbilical incision. Phillipp J Surg Spec 18:188–193

    CAS  Google Scholar 

  16. Kashimura N, Kusachi S, Konishi T et al (2012) Impact of surgical site infection after colorectal surgery on hospital stay and medical expenditure in Japan. Surg Today 42:639–645

    Article  PubMed  Google Scholar 

  17. Anderson DJ, Kaye KS, Classen D et al (2008) Strategies to prevent surgical site infections in acute care hospitals. Inf Cont Hosp Epideiol 29:S51–S61

    Article  Google Scholar 

  18. Glyn GJ (2006) The anatomy of general surgical operations, 3rd edn. Churchill Livingstone, Philadelphia, pp 6–7

    Google Scholar 

  19. Chummy SS, Raymond JL (2006) Last’s anatomy. In: Elsevier Health Sciences, 11th edn. Maryland Heights, pp 240–241

  20. Braga M, Vignali A, Zuliani W et al (2005) Laparoscopic versus open colorectal surgery; cost-benefit analysis in a single-center randomized trial. Ann Surg 242:890–896

    Article  PubMed  PubMed Central  Google Scholar 

  21. Guillou P, Quirke P, Thorpe H et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal (MRC CLASICC trial): multicenter, randomized controlled trial. Lancet 365:1718–1172

    Article  PubMed  Google Scholar 

  22. Hamzaoglu I, Baca B, Boler DE et al (2004) Is umbilical flora responsible for surgical site infection after laparoscopic surgery? Surg Laparosc Endosc Percutan Tech 14:263–267

    Article  PubMed  Google Scholar 

  23. Tschudin-Sutter S, Frei R, Egli-Gany D et al (2012) No risk of surgical site infections from residual bacteria after disinfection with povidone-iodine-alcohol in 1014 cases: a prospective observational study. Ann Surg 255:565–569

    Article  PubMed  Google Scholar 

  24. Cervantes-Sanchez CR, Gutierrez-Vega R, Vazquez-Carpizo JA et al (2000) Syringe pressure irrigation of subdermic tissue after appendectomy to decrease the incidence of postoperative wound infection. Would J Surg 24:38–41

    Article  CAS  Google Scholar 

  25. Mazuski JE, Sawyer RG, Nathens AB et al (2002) The Surgical Infection Society guidelines on antimicrobial therapy for intra-abdominal infections: evidence for the recommendations. Surg Infect 3:161–173

    Article  Google Scholar 

  26. Zhang HY, Zhao CL, Xie J et al (2016) To drain or not to drain in colorectal anastomosis: a meta-analysis. Int J Color Dis 31:951–960

    Article  Google Scholar 

Download references

Acknowledgements

The authors thank all members of the Iwate Medical University School of Medicine for their excellent assistance. The authors would like to thank Enago ( www.enago.jp ) for the English language review.

Author information

Authors and Affiliations

  1. Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan

    Mizunori Yaegashi, Koki Otsuka, Toshimoto Kimura, Masanori Hakozaki, Megumu Kamishima, Tomoki Hatanaka, Kei Sato, Hitoshi Fujii, Teppei Matsuo & Akira Sasaki

Authors
  1. Mizunori Yaegashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Koki Otsuka
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Toshimoto Kimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Masanori Hakozaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Megumu Kamishima
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tomoki Hatanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kei Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hitoshi Fujii
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Teppei Matsuo
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Akira Sasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mizunori Yaegashi.

Ethics declarations

Financial disclosures

No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yaegashi, M., Otsuka, K., Kimura, T. et al. Transumbilical abdominal incision for laparoscopic colorectal surgery does not increase the risk of postoperative surgical site infection. Int J Colorectal Dis 32, 715–722 (2017). https://doi.org/10.1007/s00384-017-2753-4

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-017-2753-4

Keywords

Search

Navigation