Don't give up on wound protectors yet

Abstract

Dear Editor,IreadwithinterestthepaperpublishedbyDr.LauscherJCandcolleagues [1] reporting the results of randomized trial com-paring wound ring plastic drapes vs simple wet cloth towels toprevent surgical site infections (SSI) after laparoscopic colo-rectal surgery. The authors concluded that “ring drapes do notreduce the rate of SSIs in laparoscopic colorectal surgery”.Inmy opinion, the authors are wrong in drawing such a conclu-sion. Their trial had to be prematurely stopped due to recruit-ment problems, so it is clear that the results should beinterpretedwithcautionbecauseoflackofpower.Anyabsenceofstatisticallysignificantdifferencecanbetheoreticallyrelatedto a beta-error (concluding on a false equivalence). Further-more,insteadofdiscussinghowsurgeonscandecreasetherateofSSIswithothermeans,theauthorsshouldinfactdiscussthelimitations of their trial. Because of these flaws, the presenttrial does not involve any evidence allowing us to abandonwound protectors in our daily practice. Once again we arefacing in surgical literature a randomized trial which does notreach optimal quality to answer our questions in this field [2].Recently, a meta-analysis (published following the acceptanceofthepresentpaperforpublication)concludedthat(atleastforopen digestive surgery) wound protectors do reduce rates ofSSIs by half, the differences being significant with dual-ringimpervious plastic protectors [ 3]. The number needed to treatwas as low as ten patients to prevent one SSI. I do not thinklaparoscopicsurgeryshouldberegardeddifferentlyfromopensurgery concerning the preventive measures against the risk ofwound infection. From an ethical aspect and by taking intoaccount the results of the published meta-analysis [3] and theflaws of the present trial [1], we cannot give up yet woundprotectors whether in open or laparoscopic surgery.