Port site infection in laparoscopic surgery: A review of its management

Abstract

Laparoscopic surgery (LS), also termed minimal access surgery, has brought a paradigm shift in the approach to modern surgical care. Early postoperative recovery, less pain, improved aesthesis and early return to work have led to its popularity both amongst surgeons and patients. Its application has progressed from cholecystectomies and appendectomies to various other fields including gastrointestinal surgery, urology, gynecology and oncosurgery. However, LS has its own package of complications. Port site infection (PSI), although infrequent, is one of the bothersome complications which undermine the benefits of minimal invasive surgery. Not only does it add to the morbidity of the patient but also spoils the reputation of the surgeon. Despite the advances in the field of antimicrobial agents, sterilization techniques, surgical techniques, operating room ventilation, PSIs still prevail. The emergence of rapid growing atypical mycobacteria with multidrug resistance, which are the causative organism in most of the cases, has further compounded the problem. PSIs are preventable if appropriate measures are taken preoperatively, intraoperatively and postoperatively. PSIs can often be treated non-surgically, with early identification and appropriate management. Macrolides, quinolones and aminoglycosides antibiotics do show promising activity against the atypical mycobacteria. This review article highlights the clinical burden, presentations and management of PSIs in LS as shared by various authors in the literature. We have given emphasis to atypical mycobacteria, which are emerging as a common etiological agent for PSIs in LS. Although the existing literature lacks consensus regarding PSI management, the complication can be best avoided by strictly abiding by the commandments of sterilization techniques of the laparoscopic instruments with appropriate sterilizing agent.

Keywords: Laparoscopic surgery, Port site infection, Atypical mycobacteria, Sterilization, Surgical site infections

Core tip: Laparoscopic surgery has brought about a paradigm shift in the approach to various surgical diseases. Port site infection, although infrequent, is a complication which can undermine the benefits of the surgery. The complication is not life threatening, but definitely adds a lot to the morbidity, affects the postoperative quality of life, and spoils the aesthesis of the surgery. Leaving aside the bacterial causes, the rapidly emerging multidrug resistant atypical mycobacteria are a constant threat. By doing a thorough review of this topic, this paper aims to present the relevant literature regarding the diagnosis, currently available treatment options and commandments to prevent the occurrence of this somewhat preventable complication.