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Planned secondary wound closure at the circular stapler insertion site after laparoscopic gastric bypass reduces postoperative morbidity, costs, and hospital stay

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Abstract

Purpose

The aims of the present study were to assess whether planned secondary wound closure at the insertion site of the circular stapler reduces wound infection rate and postoperative morbidity after laparoscopic Roux-en-Y gastric bypass (RYGB) and to identify independent predictive factors increasing the risk for wound infections after RYGB.

Methods

This paper is a retrospective single-center analysis of a prospectively collected database of 1400 patients undergoing RYGB surgery in circular technique between June 2000 and June 2016. Planned secondary wound closure at the circular stapler introduction site was performed at postoperative day 3 in 291 (20.8%) consecutive patients and compared to a historical control of 1109 (79.2%) consecutive patients with primary wound closure. Independent predictive factors for wound infection were assessed by multivariable analysis.

Results

Secondary wound closure significantly decreased wound infection rate from 9.3% (103/1109) to 1% (3/291) (p < 0.001) leading to a shorter hospital stay (mean 9 (SD8) vs. 7 days (SD2), p < 0.001), lower costs (p = 0.039), and reduced postoperative morbidity (mean 90-day Comprehensive Complication Index (CCI) 7.4 (SD14.0) vs. 5.1 (SD11.1) p = 0.008) when compared to primary wound closure. Primary wound closure, dyslipidemia, and preoperative gastritis were independent predictive risk factors for developing wound infections both in the univariate (p < 0.001; p = 0.048; p = 0.003) and multivariable analysis (p < 0.001; p = 0.040; p = 0.012). Further, on multivariable analysis, the female gender was a predictive factor (p = 0.034) for wound infection development.

Conclusions

Secondary wound closure at the circular stapler introduction site in laparoscopic RYGB significantly reduces the overall wound infection rate as well as postoperative morbidity, costs, and hospital stay when compared to primary wound closure.

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Authors and Affiliations

  1. Department of Abdominal and Transplant Surgery, University Hospital of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland

    Diana Vetter, Dimitri Aristotle Raptis, Mira Giama, Hanna Hosa & Marco Bueter

  2. Department of Surgery, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland

    Markus K. Muller

  3. Department of Surgery, Cantonal Hospital Baden, 5405, Baden, Switzerland

    Antonio Nocito

  4. Department of Surgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland

    Marc Schiesser

  5. Department of Medical Controlling, University Hospital of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland

    Rudolf Moos

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  1. Diana Vetter
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Contributions

Diana Vetter contributed to the study design, interpretation and analysis of data, and writing of the manuscript; Dimitri A. Raptis, study design, statistical analysis and interpretation of the data, and revision of the manuscript; Mira Giama, data acquisition and revision of the manuscript; Hanna Hosa, data acquisition and revision of the manuscript; Markus K. Mueller, acquisition of patients and their data and critical revision of the manuscript; Antonio Nocito, acquisition of patients and their data and critical revision of the manuscript; Marc Schiesser, acquisition of patients and their data and critical revision of the manuscript; Marco Bueter, study concept and design, interpretation of data, and critical revision of the manuscript.

Corresponding author

Correspondence to Marco Bueter.

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Ethical approval

The institutional review board (IRB) of the Canton Zurich, Switzerland, approved the study (KEK-ZH-Nr.2016-00022). Informed consent was not necessary, as the analysis used anonymous, routine clinical data from our hospital. Patient data were anonymized and de-identified prior to analysis. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare that they have no conflict of interest.

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Vetter, D., Raptis, D.A., Giama, M. et al. Planned secondary wound closure at the circular stapler insertion site after laparoscopic gastric bypass reduces postoperative morbidity, costs, and hospital stay. Langenbecks Arch Surg 402, 1255–1262 (2017). https://doi.org/10.1007/s00423-017-1632-3

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  • DOI: https://doi.org/10.1007/s00423-017-1632-3

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