Dear Editor,
I read with interest the paper published by Dr. Lauscher JC and colleagues [1] reporting the results of randomized trial comparing wound ring plastic drapes vs simple wet cloth towels to prevent surgical site infections (SSI) after laparoscopic colorectal surgery. The authors concluded that “ring drapes do not reduce the rate of SSIs in laparoscopic colorectal surgery”. In my opinion, the authors are wrong in drawing such a conclusion. Their trial had to be prematurely stopped due to recruitment problems, so it is clear that the results should be interpreted with caution because of lack of power. Any absence of statistically significant difference can be theoretically related to a beta-error (concluding on a false equivalence). Furthermore, instead of discussing how surgeons can decrease the rate of SSIs with other means, the authors should in fact discuss the limitations of their trial. Because of these flaws, the present trial does not involve any evidence allowing us to abandon wound protectors in our daily practice. Once again we are facing in surgical literature a randomized trial which does not reach optimal quality to answer our questions in this field [2]. Recently, a meta-analysis (published following the acceptance of the present paper for publication) concluded that (at least for open digestive surgery) wound protectors do reduce rates of SSIs by half, the differences being significant with dual-ring impervious plastic protectors [3]. The number needed to treat was as low as ten patients to prevent one SSI. I do not think laparoscopic surgery should be regarded differently from open surgery concerning the preventive measures against the risk of wound infection. From an ethical aspect and by taking into account the results of the published meta-analysis [3] and the flaws of the present trial [1], we cannot give up yet wound protectors whether in open or laparoscopic surgery.
References
Lauscher JC, Grittner F, Stroux A, Zimmermann M, le Claire M, Buhr HJ, Ritz JP (2012) Reduction of wound infections in laparoscopic-assisted colorectal resections by plastic wound ring drapes (REDWIL)?—a randomized controlled trial. Langenbecks Arch Surg 397:1079–1085
Slim K (2005) Limits of evidence-based surgery. World J Surg 29:606–609
Edwards JP, Ho AL, Tee MC, Dixon E, Ball CG (2012) Wound protectors reduce surgical site infection: a meta-analysis of randomized controlled trials. Ann Surg 256:53–59
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Slim, K. Don't give up on wound protectors yet. Langenbecks Arch Surg 398, 617 (2013). https://doi.org/10.1007/s00423-013-1066-5
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DOI: https://doi.org/10.1007/s00423-013-1066-5