Abstract
BackgroundSurgical site infections complicate elective laparoscopic cholecystectomies in 2,4-3,2% of cases. During the operation the gallbladder is commonly extracted with a retrieval bag. We conducted a meta-analysis to clarify whether its use plays a role in preventing infections.MethodsInclusion criteria: elective cholecystectomy, details about the gallbladder extraction and data about local or systemic infection rate. Exclusion criteria: cholecystitis, jaundice, concurrent antibiotic therapy, immunosuppression, cancer. A comprehensive literature search of PubMed, Cochrane Library and MEDLINE databases was carried out independently by two researchers, according to the PRISMA guidelines and applying the GRADE approach. Terms used were (“gallbladder”AND(“speciment”OR“extraction”OR“extract”))OR(“gallbladder”OR“cholecystectomy”)AND(“bag”OR“retrieval|”OR|“endobag”OR“endocatch”).ResultsThe comprehensive literature revealed 279 articles. The eligible studies were 2 randomized trials and a multicentre prospective study. Wound infections were documented in 14 on 334 (4,2%) patients operated using a retrieval bag versus 16 on 271 (5,9%) patients operated without the use of a retrieval bag. The statistical analysis revealed a risk ratio (RR) of 0.82 (0.41–1.63 95% CI). Concerning sensitivity analysis the estimated pooled RR ranged from 0.72 to 0.96, both not statistically significant. Harbord test did not reveal the occurrence of small-study effect (p = 0.892) and the funnel-plot showed no noteworthy pattern.ConclusionsThe results of this review highlight the paucity of well-designed large studies and despite limitations related to the low level of evidence, our meta-analysis showed no significant benefit of retrieval bags in reducing the infection rate after elective laparoscopic cholecystectomy. In absence of acute cholecystitis, accidental intraoperative gallbladder perforation or suspected carcinoma their use, to date, may not be mandatory, so that, further studies focusing on complex cases are needed.
Highlights
Surgical site infections complicate elective laparoscopic cholecystectomies in 2,4-3,2% of cases
The meta-analysis was performed by pooling the Risk Ratios (RR) of each study, i.e. P1 / P0, where P1 and P0 are the infection rate of patients using or not the retrieval bag
Harling et al [16] compared groups receiving a dose of cefuroxime (750 mg i.v.) or having the gallbladder removed with a retrieval bag
Summary
Surgical site infections complicate elective laparoscopic cholecystectomies in 2,4-3,2% of cases. During the operation the gallbladder is commonly extracted with a retrieval bag. The incidence of surgical site infection (SSI) was found to be 2.4–3.2% in a large meta-analysis of studies on perioperative antibiotics in patients undergoing laparoscopic cholecystectomy [1]. In order to avoid surgical site contamination from bile and stone spillage, surgeons pay attention not to open the gallbladder during dissection from the liver bed and retrieval from the abdominal cavity. Endoscopic bags should be used when gallbladder cancer is suspected, in order to minimize the risk of tumor cell dissemination [3] and in case of acute cholecystitis to avoid spillage of infected bile, stones or pus [4,5,6]. Are retrieval bags useful in preventing wound infections in elective laparoscopic cholecystectomy?
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