Yang Zhang1, Oscar K Serrano1, W Scott Melvin1, Diego Camacho2. 1. Montefiore Institute for Minimally Invasive Surgery, Montefiore Medical Center, Bronx, New York; Albert Einstein College of Medicine, Department of Surgery, Bronx, New York. 2. Montefiore Institute for Minimally Invasive Surgery, Montefiore Medical Center, Bronx, New York; Albert Einstein College of Medicine, Department of Surgery, Bronx, New York. Electronic address: DICAMACH@montefiore.org.
Abstract
BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been established as one of the most effective treatments for morbid obesity. Surgical site infections are the most common complication after LRYGB surgery. OBJECTIVE: To compare the superficial surgical site infections (sSSI) rate before and after the implementation of our intraoperative technique. SETTING: Academic medical center. METHODS: Our intraoperative technique relies on sterile coverage of the circular stapler, sterile specimen-bag retrieval of the gastrojejunostomy enteric remnant, and port site Penrose drainage. We analyzed our sSSI outcomes before and after implementation of our technique in all LRYGBs performed by a single surgeon from 2009 to 2015. We took into account patient age; sex; baseline body mass index (BMI); smoking status; and co-morbidities such as diabetes, hypertension, and hyperlipidemia. χ(2) and multivariate analysis were performed. RESULTS: We performed 486 LRYGBs in 2009-2015. The cohort before implementation of our technique (group 1) included 164 patients (33.7%) and the cohort after implementation (group 2) included 322 patients (66.3%). Both groups were similar in age, sex, smoking status, and rates of diabetes and hyperlipidemia but differed in BMI, operative time, and prevalence of hypertension. Hypertension was not a confounder for sSSI (P = .35). The sSSI rate was 9.15% for group 1 and 3.42% for group 2 (P = .0079). Controlling for BMI and operative time, multivariate analysis revealed a significant reduction in sSSI (odds ratio 2.98 [95% CI 1.33-6.69]) with our technique. CONCLUSIONS: We describe a reproducible intraoperative technique that significantly reduces sSSI in LRYGB procedures. Our technique has the potential of hastening postoperative recovery.
BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been established as one of the most effective treatments for morbid obesity. Surgical site infections are the most common complication after LRYGB surgery. OBJECTIVE: To compare the superficial surgical site infections (sSSI) rate before and after the implementation of our intraoperative technique. SETTING: Academic medical center. METHODS: Our intraoperative technique relies on sterile coverage of the circular stapler, sterile specimen-bag retrieval of the gastrojejunostomy enteric remnant, and port site Penrose drainage. We analyzed our sSSI outcomes before and after implementation of our technique in all LRYGBs performed by a single surgeon from 2009 to 2015. We took into account patient age; sex; baseline body mass index (BMI); smoking status; and co-morbidities such as diabetes, hypertension, and hyperlipidemia. χ(2) and multivariate analysis were performed. RESULTS: We performed 486 LRYGBs in 2009-2015. The cohort before implementation of our technique (group 1) included 164 patients (33.7%) and the cohort after implementation (group 2) included 322 patients (66.3%). Both groups were similar in age, sex, smoking status, and rates of diabetes and hyperlipidemia but differed in BMI, operative time, and prevalence of hypertension. Hypertension was not a confounder for sSSI (P = .35). The sSSI rate was 9.15% for group 1 and 3.42% for group 2 (P = .0079). Controlling for BMI and operative time, multivariate analysis revealed a significant reduction in sSSI (odds ratio 2.98 [95% CI 1.33-6.69]) with our technique. CONCLUSIONS: We describe a reproducible intraoperative technique that significantly reduces sSSI in LRYGB procedures. Our technique has the potential of hastening postoperative recovery.
Authors: Alexander C Barr; Kathleen L Lak; Melissa C Helm; Tammy L Kindel; Rana M Higgins; Jon C Gould Journal: Surg Endosc Date: 2019-02-25 Impact factor: 4.584
Authors: Diana Vetter; Dimitri Aristotle Raptis; Mira Giama; Hanna Hosa; Markus K Muller; Antonio Nocito; Marc Schiesser; Rudolf Moos; Marco Bueter Journal: Langenbecks Arch Surg Date: 2017-10-18 Impact factor: 3.445