Does using a laparoscopic approach to cholecystectomy decrease the risk of surgical site infection?

Chesley Richards; Jonathan Edwards; David Culver; T Grace Emori; James Tolson; Robert Gaynes; National Nosocomial Infections Surveillance (NNIS) System, Centers for Disease Control and Prevention

doi:10.1097/01.sla.0000055221.50062.7a

PubMed · 12616119

Does using a laparoscopic approach to cholecystectomy decrease the risk of surgical site infection?

Chesley Richards·Jonathan Edwards·David Culver·T Grace Emori·James Tolson·Robert Gaynes·National Nosocomial Infections Surveillance (NNIS) System, Centers for Disease Control and Prevention

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Abstract

OBJECTIVE: To assess the impact of laparoscopy on surgical site infections (SSIs) following cholecystectomy in a large population of patients. SUMMARY BACKGROUND DATA: Previous investigations have demonstrated that laparoscopic cholecystectomy is associated with a shorter postoperative stay and fewer overall complications. Less is known about the impact of laparoscopy on the risk for SSIs. METHODS: Epidemiologic analysis was performed on data collected during a 7-year period (1992-1999) by participating hospitals in the National Nosocomial Infections Surveillance (NNIS) System in the United States. RESULTS: For 54,504 inpatient cholecystectomy procedures reported, use of the laparoscopic technique increased from 59% in 1992 to 79% in 1999. The overall rate of SSI was significantly lower for laparoscopic cholecystectomy than for open cholecystectomy. Overall, infecting organisms were similar for both approaches. Even after controlling for other significant factors, the risk for SSI was lower in patients undergoing the laparoscopic technique than the open technique. CONCLUSIONS: Laparoscopic cholecystectomy is associated with a lower risk for SSI than open cholecystectomy, even after adjusting for other risk factors. For interhospital comparisons, SSI rates following cholecystectomy should be stratified by the type of technique.

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Chesley Richards, Jonathan Edwards, David Culver, T Grace Emori, James Tolson, Robert Gaynes, National Nosocomial Infections Surveillance (NNIS) System, Centers for Disease Control and Prevention. 2003. Does using a laparoscopic approach to cholecystectomy decrease the risk of surgical site infection?. https://doi.org/10.1097/01.sla.0000055221.50062.7a

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PubMed2006

Small-incision versus open cholecystectomy for patients with symptomatic cholecystolithiasis.

BACKGROUND: Cholecystectomy is one of the most frequently performed operations. Open cholecystectomy has been the gold standard for over 100 years. Small-incision cholecystectomy is a less frequently used alternative. OBJECTIVES: To compare the beneficial and harmful effects of small-incision versus open cholecystectomy for patients with symptomatic cholecystolithiasis. SEARCH STRATEGY: We searched TheCochrane Hepato-Biliary Group Controlled Trials Register (6 April 2004), The Cochrane Library (Issue 1, 2004), MEDLINE (1966 to January 2004), EMBASE (1980 to January 2004), Web of Science (1988 to January 2004), and CINAHL (1982 to January 2004) for randomised trials. SELECTION CRITERIA: All published and unpublished randomised trials in patients with symptomatic cholecystolithiasis comparing any kind of small-incision or other kind of minimal incision cholecystectomy versus any kind of open cholecystectomy. No language limitations were applied. DATA COLLECTION AND ANALYSIS: Two authors independently performed selection of trials and data extraction. The methodological quality of the generation of the allocation sequence, allocation concealment, blinding, and follow-up was evaluated to assess bias risk. Analyses were based on the intention-to-treat principle. Authors were requested additional information in case of missing data. Sensitivity and subgroup analyses were performed if appropriate. MAIN RESULTS: Seven trials randomised 571 patients. Bias risk was high in the included trials. No mortality was reported. The total complication proportions are respectively 9.9% and 9.3% in the small-incision and open group, which is not significantly different (risk difference all trials, random-effects 0.00, 95% confidence interval (CI) -0.06 to 0.07). There are also no significant differences considering severe complications and bile duct injuries. However, small-incision cholecystectomy has a shorter hospital stay (weighted mean difference, random-effects -2.8 days (95% CI -4.9 to -0.6)) compared to open cholecystectomy. AUTHORS' CONCLUSIONS: Small-incision and open cholecystectomy seem to be equivalent regarding risks of complications, but the latter method is associated with a significantly longer hospital stay. The quicker recovery of small-incision cholecystectomy compared with open cholecystectomy confirms the existing preference of this technique over open cholecystectomy.

Cholecystectomy↗

PubMed2006

Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis.

BACKGROUND: Cholecystectomy is one of the most frequently performed operations. Open cholecystectomy has been the gold standard for over 100 years. Small-incision cholecystectomy is a less frequently used alternative. Laparoscopic cholecystectomy was introduced in the 1980s. OBJECTIVES: To compare the beneficial and harmful effects of laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis. SEARCH STRATEGY: We searched TheCochrane Hepato-Biliary Group Controlled Trials Register (6 April 2004), The Cochrane Library (Issue 1, 2004), MEDLINE (1966 to January 2004), EMBASE (1980 to January 2004), Web of Science (1988 to January 2004), and CINAHL (1982 to January 2004) for randomised trials. SELECTION CRITERIA: All published and unpublished randomised trials in patients with symptomatic cholecystolithiasis comparing any kind of laparoscopic cholecystectomy versus small-incision or other kind of minimal incision open cholecystectomy. No language limitations were applied. DATA COLLECTION AND ANALYSIS: Two authors independently performed selection of trials and data extraction. The methodological quality of the generation of the allocation sequence, allocation concealment, blinding, and follow-up was evaluated to assess bias risk. Analyses were based on the intention-to-treat principle. Authors were requested additional information in case of missing data. Sensitivity and subgroup analyses were performed if appropriate. MAIN RESULTS: Thirteen trials randomised 2337 patients. Methodological quality was relatively high considering the four quality criteria. Total complications of laparoscopic and small-incision cholecystectomy are high: 26.6% versus 22.9%. Total complications (risk difference, random-effects -0.01, 95% confidence interval (CI) -0.07 to 0.05), hospital stay (weighted mean difference (WMD), random-effects -0.72 days, 95% CI -1.48 to 0.04), and convalescence were not significantly different. High-quality trials show a quicker operative time for small-incision cholecystectomy (WMD, high-quality trials 'blinding', random-effects 16.4 minutes, 95% CI 8.9 to 23.8) while low-quality trials show no significant difference. AUTHORS' CONCLUSIONS: Laparoscopic and small-incision cholecystectomy seem to be equivalent. No differences could be observed in mortality, complications, and postoperative recovery. Small-incision cholecystectomy has a significantly shorter operative time. Complications in elective cholecystectomy are prevalent.

Cholecystectomy↗

PubMed2006

Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis.

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