Ulus Travma Acil Cerrahi Derg. 2023; 29(2): 203-211 | DOI: 10.14744/tjtes.2022.97828

Is it necessary to use specimen retrieval bag for reducing surgical site infection in laparoscopic appendectomy?A randomized controlled trial

Mustafa Sami Bostan, Celil Uðurlu
Department of General Surgery, Tokat Gaziosmanpaþa University Faculty of Medicine, Tokat-Türkiye

BACKGROUND: The aim of the study was to investigate the comparison the effects of the extraction of specimen by using a specimen retrieval bag (SRB) or direct extraction through trochar in terms of surgical site infection (SSI) in patients who underwent laparoscopic appendectomy.
METHODS: A total of 165 patients were randomly allocated into two groups. A SRB was used in 77 patients (Group 1, 46.7%) and not used in 88 patients (Group 2, 53.3%). Demographics, comorbid diseases, laboratory results, preoperative diameter of appendix, intraoperative observations, intraoperative procedures, hospitalization times, SSIs, pathology results, culture results, and findings of the patients who developed complications and the treatments given to the patients due to complications during the post-operative period were recorded.
RESULTS: The mean age of the patients was 33.95 SD 13.25 (min-max: 18–78) years. No significant difference was observed in the demographics, hospitalization times, distribution of the incidence rates of diabetes mellitus, perioperative perforation, perioperative fluid/abscess, drain insertion, aspiration-irrigation, superficial incisional SSI, drainage requirement, leakage, positive culture results, and post-operative intra-abdominal infection (p>0.05) between the groups. Neutrophil and leukocyte values were statistically significantly different between the groups (p=0.044 and p=0.012, respectively). There was a significant difference between the two groups in terms of the complicated appendicitis (p=0.040). There was no significant difference in terms of the positive culture results and incidence of post-operative intra-abdominal infection between the patients in Group 1 and Group 2 in both the complicated and uncomplicated appendicitis groups (p>0.05). The difference between the patients in Group 1 and Group 2 regarding the incidence of superficial incisional SSI was significant in the uncomplicated appendicitis group (p=0.037), whereas not significant in the complicated appendicitis group (p=1.000). In the multivariate model, only perioperative perforation was observed to be the effective parameter on post-operative intra-abdominal infection at the p<0.05 level (p=0.045).
CONCLUSION: The results of the present study revealed that the use of SRB does not prevent microbial seeding in patients who underwent laparoscopic appendectomy; therefore, it was concluded that using SRB is not associated with SSI at laparoscopic appendectomy.

Keywords: Abscess, intra-abdominal infection, laparoscopic appendectomy, specimen retrieval bag; superficial incisional surgical site infection.

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Laparoskopik apendektomide cerrahi alan enfeksiyonunu azaltmak için spesimen torbasý kullanmak gerekli mi?: Randomize kontrollü bir çalýþma

Mustafa Sami Bostan, Celil Uðurlu
Tokat Gaziosmanpaþa Üniversitesi Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Tokat

AMAÇ: Laparoskopik apendektomi yapýlan hastalarda spesimen torbasý kullanýlarak veya doðrudan trokar yoluyla spesimen çýkarýlmasýnýn cerrahi alan enfeksiyonu açýsýndan etkilerinin karþýlaþtýrýlmasýný araþtýrmak.
GEREÇ VE YÖNTEM: Toplam 165 hasta rastgele iki gruba ayrýldý. Yetmiþ yedi hastada (grup 1, %46.7) spesimen torbasý kullanýlýrken 88 hastada (grup 2, %53.3) kullanýlmadý. Hastalarýn demografik özellikleri, eþlik eden hastalýklarý, laboratuvar sonuçlarý, ameliyat öncesi apendiks çapý, ameliyat sýrasýndaki bulgular, ameliyat sýrasýnda yapýlan iþlemler, hastanede kalýþ süreleri, cerrahi alan enfeksiyonlarý, patoloji sonuçlarý, kültür sonuçlarý, komplikasyon geliþen hastalarýn bulgularý ve ameliyat sonrasýnda geliþen komplikasyonlar nedeniyle hastalara verilen tedaviler kaydedildi.
BULGULAR: Hastalarýn yaþ ortalamasý 33.95 SD 13.25 (min-maks: 18–78) idi. Demografik özellikler, hastanede yatýþ süreleri, DM insidans oranlarýnýn daðýlýmý, peroperatif perforasyon, peroperatif sývý/apse, dren konulmasý, aspirasyon-irrigasyon, yüzeyel kesi yeri enfeksiyonu, drenaj gereksinimi, güdük kaçaðý, pozitif kültür sonuçlarý, ameliyat sonrasý karýn içi enfeksiyon (p>0.05) açýsýndan gruplar arasýnda anlamlý farklýlýk izlenmedi. Nötrofil ve lökosit deðerleri gruplar arasýnda istatistiksel olarak anlamlý farklýlýk gösterdi (sýrasýyla, p=0.044, p=0.012). Komplike apandisit açýsýndan iki grup arasýnda anlamlý fark vardý (p=0.040). Hem komplike hem de komplike olmayan apandisit gruplarýnda grup 1 ve grup 2’deki hastalar arasýnda pozitif kültür sonuçlarý ve postoperatif karýn içi enfeksiyon insidansý açýsýndan anlamlý fark yoktu (p>0.05). Yüzeyel insizyonel SSI açýsýndan grup 1 ve grup 2’deki hastalar arasýndaki fark komplike olmayan apandisit grubunda anlamlý iken (p=0.037), komplike apandisit grubunda anlamlý deðildi (p=1.000). Çok deðiþkenli modelde, p<0.05 düzeyinde postoperatif karýn içi enfeksiyon üzerinde sadece peroperatif perforasyonun etkili parametre olduðu gözlendi (p=0.045).
TARTIÞMA: Bu çalýþmanýn sonuçlarý, laparoskopik apendektomi yapýlan hastalarda spesimen torbasý kullanýmýnýn mikrobiyal ekimi engellemediðini ortaya koydu, bu nedenle laparoskopik apendektomide spesimen torbasý kullanýmýnýn cerrahi alan enfeksiyonu ile iliþkili olmadýðý sonucuna varýldý.

Anahtar Kelimeler: Apse, intraabdominal infeksiyon, laparoskopik apendektomi, spesimen torbasý; yüzeyel cerrahi alan infeksiyonu.

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