Skip to main content

Advertisement

SpringerLink
Log in

Peritoneal contamination and associated post-operative infectious complications after natural orifice specimen extraction for laparoscopic colorectal surgery

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Peritoneal contamination is a major concern during natural orifice specimen extraction after laparoscopic colorectal resection (LCR-NOSE), but few data are available. We explored the prevalence, risk factors, and association between clinical outcomes and infectious complications in patients with positive peritoneal drain fluid culture (PDFC) after LCR-NOSE.

Method

We retrospectively analyzed patient records in our prospectively maintained registry database who underwent LCR-NOSE between 2011and 2020. Peritoneal drain fluid was collected within 12 h post-operative and cultures for microorganisms were obtained. The relationships between PDFC, clinical variables, and infectious complications were examined by univariate and multivariable analysis.

Results

Of 241 consecutive patients who underwent LCR-NOSE and drainage fluid culture, 59 (24.5%) had PDFC. Anterior resection (Odds ratio OR 2.40) was identified as an independent predictor for PDFC. Twenty-eight patients (11.6%) developed infectious complications. Multivariable analysis identified low anterior resection (OR 2.74), prolonged operative time (OR 3.20), and PDFC (OR 5.14) as independent risk factors. Pseudomonas aeruginosa was the most frequently found microorganism (OR 5.19) responsible for infectious complications.

Conclusions

Microorganisms are commonly present in the peritoneum after LCR-NOSE and play a critical role in the development of infectious complications and related morbidity. Specific caution is warranted in patients contaminated with specific types of microorganisms.

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

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Chang SC, Chen HC, Chen YC, Ke TW, Tsai YY, Wang HM, Fingerhut A, Chen WT (2020) Long-term oncologic outcomes of laparoscopic anterior resections for cancer with natural orifice versus conventional specimen extraction: a case-control study. Dis Colon Rectum 63:1071–1079

    Article  PubMed  Google Scholar 

  2. Xu S, Liu K, Chen X, Yao H (2021) The safety and efficacy of laparoscopic surgery versus laparoscopic NOSE for sigmoid and rectal cancer. Surg Endosc. https://doi.org/10.1007/s00464-020-08260-6

    Article  PubMed  PubMed Central  Google Scholar 

  3. Saida Y, Nagao J, Nakamura Y, Nakamura Y, Enomoto T, Katagiri M, Kusachi S, Watanabe M, Sumiyama Y (2008) A comparison of abdominal cavity bacterial contamination of laparoscopy and laparotomy for colorectal cancers. Dig Surg 25:198–201

    Article  PubMed  Google Scholar 

  4. Senft JD, Dröscher T, Gath P, Müller PC, Billeter A, Müller-Stich BP, Linke GR (2018) Inflammatory response and peritoneal contamination after transrectal natural orifice specimen extraction (NOSE) versus mini-laparotomy: a porcine in vivo study. Surg Endosc 32:1336–1343

    Article  PubMed  Google Scholar 

  5. Leroy J, Costantino F, Cahill RA, D’Agostino J, Morales A, Mutter D, Marescaux J (2011) Laparoscopic resection with transanal specimen extraction for sigmoid diverticulitis. Br J Surg 98:1327–1334

    Article  CAS  PubMed  Google Scholar 

  6. Costantino FA, Diana M, Wall J, Leroy J, Mutter D, Marescaux J (2012) Prospective evaluation of peritoneal fluid contamination following transabdominal vs. transanal specimen extraction in laparoscopic left-sided colorectal resections. Surg Endosc 26:1495–1500

    Article  PubMed  Google Scholar 

  7. Müller PC, Dube A, Steinemann DC, Senft JD, Gehrig T, Benner L, Nickel F, Müller-Stich BP, Linke GR (2018) Contamination after disinfectant rectal washout in left colectomy as a model for transrectal NOTES: a randomized controlled trial. J Surg Res 232:635–642

    Article  PubMed  Google Scholar 

  8. Anonymous (2012) American College of Surgeons National Surgical Quality Improvement Program: Chicago, 2012. User Guide for the 2012 Participant Use Data File

  9. Pessaux P, Msika S, Atalla D, Hay JM, Flamant Y (2003) Risk factors for postoperative infectious complications in noncolorectal abdominal surgery: a multivariate analysis based on a prospective multicenter study of 4718 patients. Arch Surg-Chicago 138:314–324

    Article  PubMed  Google Scholar 

  10. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  11. Sartelli M, Catena F, Di Saverio S, Ansaloni L, Malangoni M, Moore EE, Moore FA, Ivatury R, Coimbra R, Leppaniemi A, Biffl W, Kluger Y, Fraga GP, Ordonez CA, Marwah S, Gerych I, Lee JG, Tranà C, Coccolini F, Corradetti F, Kirkby-Bott J (2014) Current concept of abdominal sepsis: WSES position paper. World J Emerg Surg 9:22–22

    Article  PubMed  PubMed Central  Google Scholar 

  12. Chen WT, Chang SC, Chiang HC, Lo WY, Jeng LB, Wu C, Ke TW (2011) Single-incision laparoscopic versus conventional laparoscopic right hemicolectomy: a comparison of short-term surgical results. Surg Endosc 25:1887–1892

    Article  PubMed  Google Scholar 

  13. Saurabh B, Chang SC, Ke TW, Huang YC, Kato T, Wang HM, Tzu-Liang Chen W, Fingerhut A (2017) Natural orifice specimen extraction with single stapling colorectal anastomosis for laparoscopic anterior resection: feasibility, outcomes, and technical considerations. Dis Colon Rectum 60:43–50

    Article  PubMed  Google Scholar 

  14. Chang SC, Lee TH, Chen YC, Chen MT, Chen HC, Ke TW, Tsai YY, Fingerhut A, Chen WT (2021) Natural orifice versus conventional mini-laparotomy for specimen extraction after reduced-port laparoscopic surgery for colorectal cancer: propensity score-matched comparative study. Surg Endosc 36:155. https://doi.org/10.1007/s00464-020-08250-8

    Article  PubMed  Google Scholar 

  15. Li VK, Wexner SD, Pulido N, Wang H, Jin HY, Weiss EG, Nogeuras JJ, Sands DR (2009) Use of routine intraoperative endoscopy in elective laparoscopic colorectal surgery: can it further avoid anastomotic failure? Surg Endosc 23:2459–2465

    Article  PubMed  Google Scholar 

  16. Guan X, Liu Z, Longo A, Cai J-C, Tzu-Liang Chen W, Chen L-C, Chun H-K, da Costa M, Pereira J, Efetov S, Escalante R, He Q-S, Hu J-H, Kayaalp C, Kim S-H, Khan JS, Kuo L-J, Nishimura A, Nogueira F, Okuda J, Saklani A, Shafik AA, Shen M-Y, Son J-T, Song J-M, Sun D-H, Uehara K, Wang G-Y, Wei Y, Xiong Z-G, Yao H-L, Yu G, Yu S-J, Zhou H-T, Lee S-H, Tsarkov PV, Fu C-G, Wang X-S, International Alliance of N (2019) International consensus on natural orifice specimen extraction surgery (NOSES) for colorectal cancer. Gastroenterol Rep (Oxf) 7:24–31

    Article  Google Scholar 

  17. Miller K, Moritz E (1996) Circular stapling techniques for low anterior resection of rectal carcinoma. Hepatogastroenterology 43:823–831

    CAS  PubMed  Google Scholar 

  18. Targarona EM, Rodríguez M, Camacho M, Balagué C, Gich I, Vila L, Trias M (2006) Immediate peritoneal response to bacterial contamination during laparoscopic surgery. Surg Endosc 20:316–321

    Article  CAS  PubMed  Google Scholar 

  19. Scheithauer TP, Dallinga-Thie GM, de Vos WM, Nieuwdorp M, van Raalte DH (2016) Causality of small and large intestinal microbiota in weight regulation and insulin resistance. Mol Metab 5:759–770

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Linke GR, Tarantino I, Bruderer T, Celeiro J, Warschkow R, Tarr PE, Müller-Stich BP, Zerz A (2012) Transvaginal access for NOTES: a cohort study of microbiological colonization and contamination. Endoscopy 44:684–689

    Article  CAS  PubMed  Google Scholar 

  21. Rovera F, Dionigi G, Boni L, Piscopo C, Masciocchi P, Alberio MG, Carcano G, Diurni M, Dionigi R (2007) Infectious complications in colorectal surgery. Surg Oncol 16:S121-124

    Article  PubMed  Google Scholar 

  22. Song F, Glenny AM (1998) Antimicrobial prophylaxis in colorectal surgery: a systematic review of randomized controlled trials. Br J Surg 85:1232–1241

    Article  CAS  PubMed  Google Scholar 

  23. Jamali FR, Soweid AM, Dimassi H, Bailey C, Leroy J, Marescaux J (2008) Evaluating the degree of difficulty of laparoscopic colorectal surgery. Arch Surg-Chicago 143:762–767 (discussion 768)

    Article  PubMed  Google Scholar 

  24. Zhou S, Pei W, Li Z, Zhou H, Liang J, Liu Q, Zhou Z, Wang X (2020) Evaluating the predictive factors for anastomotic leakage after total laparoscopic resection with transrectal natural orifice specimen extraction for colorectal cancer. Asia Pac J Clin Oncol 16:326–332

    Article  PubMed  Google Scholar 

  25. Watanabe T, Miyata H, Konno H, Kawai K, Ishihara S, Sunami E, Hirahara N, Wakabayashi G, Gotoh M, Mori M (2017) Prediction model for complications after low anterior resection based on data from 33,411 Japanese patients included in the National Clinical Database. Surgery 161:1597–1608

    Article  PubMed  Google Scholar 

  26. Stavrou G, Kotzampassi K (2017) Gut microbiome, surgical complications and probiotics. Ann Gastroenterol 30:45–53

    PubMed  Google Scholar 

  27. Olivas AD, Shogan BD, Valuckaite V, Zaborin A, Belogortseva N, Musch M, Meyer F, Trimble WL, An G, Gilbert J, Zaborina O, Alverdy JC (2012) Intestinal tissues induce an SNP mutation in Pseudomonas aeruginosa that enhances its virulence: possible role in anastomotic leak. PLoS ONE 7:e44326–e44326

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

Drs. Sheng-Chi Chang, Tsung-Han Lee, Yi-Chang Chen, Hung-Chang Chen, Tao-Wei Ke, Yuan-Yao Tsai, Abe Fingerhut, and William Tzu-Liang Chen have no conflicts of interest or financial ties to disclose

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Division of Colorectal Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan

    Sheng-Chi Chang, Tao-Wei Ke, Yi-Chang Chen, Hung-Chang Chen, Yuan-Yao Tsai & William Tzu-Liang Chen

  2. Department of Life Sciences, National Chung Hsing University, No.145, Rd. Xingda, Taichung, 40227, Taiwan

    Sheng-Chi Chang & Tsung-Han Lee

  3. Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Minimally Invasive Surgery Center, Shanghai, 200025, People’s Republic of China

    Abe Fingerhut

  4. Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria

    Abe Fingerhut

  5. Division of Colorectal Surgery, Department of Surgery, China Medical University Hsinchu Hospital, China Medical University, No. 2, Yu-Der Rd, Taichung, 404327, Taiwan

    William Tzu-Liang Chen

Authors
  1. Sheng-Chi Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tsung-Han Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tao-Wei Ke
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yi-Chang Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hung-Chang Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yuan-Yao Tsai
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Abe Fingerhut
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. William Tzu-Liang Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization: S-CC, AF, WT-LC. Data curation: S-CC, Y-CC, Y-YT, T-WK. Formal analysis: S-CC, T-HL. Investigation: S-CC, H-CC. Methodology: S-CC, Y-YT. Project administration: AF, WT-LC. Supervision: T-HL, AF, WT-LC. Validation: T-HL, AF, WT-LC. Writing—original draft: S-CC. Writing—review & editing: AF, WT-LC.

Corresponding authors

Correspondence to Tsung-Han Lee or William Tzu-Liang Chen.

Ethics declarations

Disclosures

Drs. Sheng-Chi Chang, Tsung-Han Lee, Yi-Chang Chen, Hung-Chang Chen, Tao-Wei Ke, Yuan-Yao Tsai, Abe Fingerhut, and William Tzu-Liang Chen have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chang, SC., Lee, TH., Ke, TW. et al. Peritoneal contamination and associated post-operative infectious complications after natural orifice specimen extraction for laparoscopic colorectal surgery. Surg Endosc 36, 8825–8833 (2022). https://doi.org/10.1007/s00464-022-09308-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-022-09308-5

Keywords

Search

Navigation