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Prophylactic negative pressure wound therapy in colorectal surgery. Effects on surgical site events: current status and call to action

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Abstract

Surgical site events, including surgical site infections (SSI), represent a major problem in general surgery. SSI are responsible of nuisance for patients, and can lead to important complications and disability, often needing prolonged postoperative stay with specific treatment and recovery in Intensive Care Units. These justify the higher costs due to SSI. Despite the growing body of evidence concerning SSI in general surgery, literature dealing with SSI after colorectal surgery is scarce, reflecting in suboptimal perception of such a relevant issue by colorectal surgeons and health authorities in Italy, though colorectal surgery is associated with higher rates of SSI. The best strategy for reducing the impact of SSI on costs of care and patients quality of life would be the development of a preventive bundle, similar to that adopted in the US through the colorectal section of the National Surgery Quality Improvement Project of the American College of Surgeons (ACS-NSQIP). This policy has been showed to significantly reduce the rates of SSI. In this scenario, incisional negative pressure wound therapy (NPWT) is likely to play a pivotal role. We herein reviewed the literature to report on the current status of preventive NPWT on surgical wounds of patients undergoing colorectal procedures with primary wound closure, suggesting evidence-based measures to reduce the impact of SSI, and to contain the costs associated with conventional NPWT devices by means of newer available technologies. Some explicative real life cases are presented.

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All procedures in our paper were in accordance with the ethical standards of the institutional as well as National research committee and with the 1964 Helsinki declaration and its later amendments.

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  1. Unit of General Surgery, Second University of Naples, Piazza Miraglia 2, 80138, Naples, Italy

    Gianluca Pellino, Guido Sciaudone, Francesco Selvaggi & Silvestro Canonico

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  1. Gianluca Pellino
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  2. Guido Sciaudone
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  3. Francesco Selvaggi
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  4. Silvestro Canonico
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Correspondence to Gianluca Pellino.

Electronic supplementary material

Appendix: Preventing SSI with NPWT in colorectal surgery: real life experience

Appendix: Preventing SSI with NPWT in colorectal surgery: real life experience

We below describe some exemplifying cases to show the effects of preventive NPWT in patients undergoing colorectal procedures.

Case 1

  1. 1.

    Figure 2. Male, >50-year-old patient undergoing laparoscopic colonic resection for a benign stricture of the transverse colon due to CD. Additional risk factors for SSI: corticosteroid drugs, obesity, smoking habit. A mini-laparotomy is performed in left hypochondrium to allow for digital examination of the small bowel, specimen extraction, and extra-corporeal anastomosis [8].

  2. 2.

    Figure 3. Follow-up: appearance of the gauze after 5 days from surgery. NPWT is working due to absorbent capacity of the gauze [8].

  3. 3.

    Figure 4. Follow-up: wound appearance at 30-days follow-up [8].

Case 2

  1. 1.

    Figure 5. Female, 31-year-old patient undergoing ileal resection and multiple strictureplasties for CD. Additional risk factor for SSI: enterocutaneous stoma, smoking habit [9].

  2. 2.

    Figure 6. Follow-up: gauze partially removed on postoperative day 3 to allow wound assessment as per protocol [9].

Case 3

Figure 7. Male, 28-year-old patient undergoing ileocaecal resection for CD. Additional risk factors: smoking habit. The patient refused NPWT application. The picture shows 14-days follow-up, when suboptimal healing is observed. The patient had superficial SSI.

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Pellino, G., Sciaudone, G., Selvaggi, F. et al. Prophylactic negative pressure wound therapy in colorectal surgery. Effects on surgical site events: current status and call to action. Updates Surg 67, 235–245 (2015). https://doi.org/10.1007/s13304-015-0298-z

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