Port Site Infection Research Articles

Frequency of Port Site Infection in Laparoscopic Cholecystectomy, Evaluation by Southampton Score: A Prospective Study

Objective: To evaluate the frequency of Port-Site Infections (PSIs) following Laparoscopic Cholecystectomy (LC) using the Southampton Scoring System and identify associated risk factors. Methodology: This prospective cross-sectional study was conducted over two years in the Department of General Surgery at Hayatabad Medical Complex, Peshawar. Data were collected using a standardized proforma and analyzed using IBM SPSS version 23.0, with a significance value set at p<0.05. The Southampton Scoring System was used to monitor and grade wound infections at discharge, 2nd week and 4th weeks post-surgery. Results: After exclusion, 841 patients were included in the study, with 471 males (56%) and 370 females (44%). The average age was 45.9 ± 12.7 years. Significant intraoperative findings included symptomatic gallbladder stones (82.5%), acute cholecystitis (26%), thick-walled gallbladder (44.4%), bile spillage into peritoneum (41.5%), and gallbladder perforation (54.6%). The frequency of port site infection with Southampton scores of 3 and above was 9.9% for the umbilical port and 27.3% for the epigastric port. Significant risk factors for SSI included symptomatic gallbladder stones, acute cholecystitis, gangrenous gallbladder, spillage into the wound, gallbladder perforation, and surgery duration exceeding 90 minutes (p<0.05). Conclusions: The Southampton Scoring System effectively identified and tracked wound infections, underscoring the need for meticulous surgical techniques and thorough postoperative care to reduce SSIs. Although wound healing was initially good, complications increased by the 2nd and 3rd week, especially at the epigastric port. Most patients show significant improvement of wound healing by 4th week. Regular monitoring and timely interventions are essential to lower SSI rates in laparoscopic surgeries.

P-796. The Deadly Raise of NTM : An Observational Study on Clinical profile and Outcome Of NTM Disease

Abstract Background NTM is ubiquitously present in the environment. When these microorganisms shed, they produce biofilms that increase the likelihood of infection. CLINICAL AND RADIOLOGICAL FEATURES OF NTM Methods STUDY PERIOD: 1 YEAR STUDY DESIGN: Cross-sectional observational study STATISTICAL ANALYSIS: Categorical variables will be expressed as % NTM VARIOUS CLINICAL SITES Results 25 cases were selected for analysis. Out of 25 (40% ) were port site infection and 12 % pulmonary. Most common symptom was discharge (60%) . Empirical antibiotics were started in 100% . ID referral was sent in all .RF were seen in 40%. Scans was showing sinus tract formation or deep seated abscess among (80%); . AFB stain was positive in 80% cases and CB-NAAT negative in 100% cases. Culture positivity in 56% , among 15 samples sent for PCR it was positive in 10 (66.6%); among 10 cases sent for sequencing 8(80%) cases were positive. Rapid growers 92% and then slow growers were seen in 8% cases. most common species was M.chelonae (28.5%) followed by M.fortuitum and abscessus (21.4%); among 3 species of abscessus sub species were able to identify in one case and it was boleti 33.3%. slow growers MAC and kansasi were identified 7% each. NTM culture was given positive but species identification was not done in 14.2% cases. Culture was negative in 44% of cases. DST was done in 14 cases and genotypic was able to do in 5 cases and erm gene detected (40%) cases. Phenotypic DST was done in all culture positive isolates(n=14), among them cotrimoxazole (92.8%); Amikacin and linezolid was sensitive in 85.7% isolates, imipenem,levofloxacin and tigecycline in 71.4% and macrolide was sensitive in 57.1% cases only. Various combination regimens were used and most common combination used were amikacin,levofloxacin,macrolide and amikacin,linezolid,levofloxacin and amikacin,levofloxacin,cotrimoxazole in 24% cases; and 1 case had treatment with amikacin,linezolid,tigecycline . 40 % cases used combination treatment for 1 year or longer;20 % cases only used 6 months of therapy. Side effects like GIT intolerance in 80% cases; renal toxicity was seen in 40% cases. Upon follow up death in 8%; resolution in 76% , culture negativity 71.4% non-resolving/recurrence 16% Conclusion Most of the patients with NTM are misdiagnosed and are treated as tuberculosis ANTIBIOTIC SUSCEPTIBILITIES AMONG VARIOUS NTM ISOLATED NTM IMAGE 4 Disclosures All Authors: No reported disclosures

Port site tuberculosis after laparoscopic cholecystectomy in resource limiting setup: Case series and literature review.

Laparoscopic cholecystectomy has become the gold standard for treating symptomatic gallstones in recent years due to its minimally invasive nature, which results in less pain, scarring, and a faster recovery time compared to traditional open surgery. Port site infection is a rare complication of laparoscopic surgery, sometimes occurring early after the procedure or developing later and the cause of these infections can vary. Port site tuberculosis (TB) is a particularly uncommon type of port site infection and represents a rare form of extra pulmonary TB. Three patients (a 63-year-old diabetic male, a 62-year-old hypertensive female, and a 34-year-old female) presented with port site discharge and pain after undergoing laparoscopic cholecystectomy at the same center during the same campaign. All patients initially received antibiotics for suspected port site infections, but these failed to resolve the symptoms. Subsequent fine needle aspiration cytology revealed port site tuberculosis (TB) in all three cases. After initiating anti-tuberculosis treatment, all patients showed significant improvement. Port site tuberculosis, a rare and often overlooked extra pulmonary manifestation of tuberculosis, can present as a port site infection following laparoscopic procedures. It is characterized by prolonged wound healing and persistent discharge, can pose diagnostic challenges, often requiring careful evaluation and appropriate investigations to ensure timely and effective treatment. Port site tuberculosis can be transmitted to patients through two main routes: exogenous or endogenous ways. Once a diagnosis of port site tuberculosis is confirmed; the next step involves treatment with a standard anti-tuberculosis regimen. Port site tuberculosis (TB) after undergoing laparoscopic cholecystectomy at the same facility, suggesting inadequate instrument sterilization as a likely cause. This case underscores the importance of considering port site TB in post-laparoscopic patients, particularly in areas with high TB prevalence, after ruling out bacterial infections. Prompt and appropriate treatment is crucial for successful outcomes.

Impact of Diabetes on Outcomes of Laparoscopic Cholecystectomy: A Prospective Study

OBJECTIVES This study aims to assess the impact of diabetes on laparoscopic cholecystectomy (LC) outcomes, as optimizing results for diabetic patients undergoing this common surgery presents unique clinical challenges. METHODOLOGY We comprehensively analyzed 258 participants, comparing 60 individuals with diabetes to 198 non-diabetic counterparts. Key variables, including age, gender, BMI, comorbidities, ASA grade, and CCI index, were assessed. Additionally, intraoperative and postoperative characteristics, ultrasound findings, and outcomes were analyzed. RESULTSDiabetic individuals exhibited advanced age, a higher BMI, and increased severity of illness based on their ASA grade and CCI index. Intraoperatively, diabetic individuals showed higher probabilities of empyema of the GB (23.3%), thick wall gallbladder (3.8%), mucocele (8.3%), gangrenous (10.8%), and other complications. The model explained variability in outcomes such as severe complications (6.6%), intraoperative hemorrhages (5%), conversion to open surgery (4.2%), and length of hospital stay (1.58±1.01 SD). Persistent pain 13 (5.03%), port site infection 30 (11.6%), intraabdominal abscess 5 (1.9%), bile duct injury 8 (3.1%), jaundice 8 (3.1%), and readmission to the hospital 4 (1.5%) were noted.CONCLUSIONDiabetic individuals undergoing laparoscopic cholecystectomy present distinct clinical features and higher probabilities of specific intraoperative and postoperative complications. The multivariate analysis provides insights into the variability of outcomes, emphasizing the importance of tailored approaches for diabetic patients in this surgical context.

Optimizing ventral hernia repair: our experience with laparoscopic intra-peritoneal onlay mesh plus

Background: Ventral hernia repair remains a challenge, with laparoscopic techniques showing potential for lower recurrence and complications. This study aimed to assess the efficacy of the Laparoscopic intra-peritoneal Onlay mesh plus (LIPOMPlus) approach in ventral hernia repair. Methods: This observational study was conducted at Ibn Sina medical college hospital, Dhaka, Bangladesh, from August 2016 to December 2017, enrolling 75 patients with ventral hernias. Patient demographics, perioperative data, and postoperative outcomes were recorded and analyzed. The primary endpoints included recurrence, postoperative complications, and patient satisfaction. Results: The mean age was 45.6±12.3 years, with a female predominance (53.3%). The average operative time was 95±20 minutes, and the mean hospital stay was 3.2±1.1 days. Complications were minimal: seroma (1.3%), hematoma (2.7%), port site infection (4%) and/or mesh infection (1.3%), and mesh rejection (1.3%). Only 2.7% of patients experienced hernia recurrence. Patients reported high satisfaction (mean score of 8.7±1.3), and the mean time to return to normal activities was 14±4 days. Conclusions: The LIPOMPlus technique for ventral hernia repair demonstrated low complication and recurrence rate, high patient satisfaction, and a favorable recovery profile. These findings support LIPOMPlus as a viable and effective approach for ventral hernia management, warranting further investigation in diverse settings.

Robotic-assisted partial nephrectomy using the HugoTM robotic-assisted surgery platform: Initial experience and insights.

Robotic-assisted surgery (RAS) is a vital modality in the armamentarium of minimally invasive surgeons. The HugoTM RAS system (Medtronic®) is one of the newest platforms on the market and has little surgical outcomes data. We describe our early experience performing robotic-assisted partial nephrectomy (RAPNx) with the Hugo RAS platform. We conducted a retrospective review of patients who underwent a RAPNx with the Hugo RAS platform between April and December 2023 at the University Health Network in Toronto, ON. One surgeon performed all procedures using a three-arm transperitoneal approach. Anesthetic, operative, and pathologic reports were assessed to collect pre-, intra- and postoperative variables. Eleven patients were included. The mean age was 51 years, 45.0% were female, and 63.6% had a right-sided mass. Mean tumor size was 2.9 cm. Mean warm ischemia time was 18.9 min (standard deviation [SD] 7.12) and mean estimated blood loss was 179 mL (SD 63.6). Mean robot docking time was 232 seconds (SD 106.5), mean total console time was 93 minutes (SD 21.4), and mean total operative time was 165.6 minutes (SD 34.1). There were no intraoperative complications. On pathology review, most tumors were a clear cell variant (72.7%) and staged pT1a (81.8%). All margins were negative. One patient sustained a port site infection. This is the first North American case series using the Hugo RAS platform for RAPNx. Our findings underscore that the platform is safe and effective for performing RAPNx with comparable outcomes to other robotic platforms.

Is the trocar through which the gallbladder is removed during cholecystectomy important for potential complications?

Objective: Laparoscopic cholecystectomy is considered the gold standard for the treatment of gallstone disease and complications can develop at trocar sites following laparoscopic cholecystectomy. This study aims to evaluate the impact of extracting the gallbladder through either the umbilical or epigastric ports during laparoscopic cholecystectomy on the complications observed after gallbladder extraction. Methods: Symptomatic cholelithiasis patients who had four port laparoscopic cholecystectomy included to the study. Individuals were divided into two groups based on gallbladder removal site: umbilical or epigastric. Medical records were reviewed for post-surgical complications within 30 days and incisional hernias within one year. The age, gender, operation duration, BMI and the largest stone dimentions of the patients were also noted. Results: A total of 112 patients were included in the study, with 45 patients in the umbilical group and 67 patients in the epigastric group. No significant differences were observed in age, gender, body mass index and stone dimentions between groups. Port site hernia and port site infection developed more frequently but not significantly in umblical group. When examined the stone dimention and BMI based on the presence of a port site hernia and port site infection, BMI and stone dimention were significantly higher in port site infection and hernia patients. Conclusion: Using umbilical port for removing gallbladder, carried a higher risk of infection and hernia development. Additionally, regardless of which trocar is used, patients with a high BMI and large stone dimensions have a higher risk of port site infection and hernia. Patients should be informed about these risks during the preoperative period.

WP8.9 - Laparoscopic Cholecystectomy Performed by a Surgical Care Practitioner: Review of Outcomes

Abstract Introduction Surgical Care Practitioners (SCPs) are non-medical workers involved in various aspects of management of surgical patients. The role includes assisting and performing surgical procedures. Over 60,000 laparoscopic cholecystectomies (LC) are performed annually in the UK. With ever increasing pressure on waiting lists, it is important to look at fully utilising the skills of our entire workforce. We report what we believe is the first published series of LC performed by an SCP. Materials and Methods A retrospective review of a prospectively collected database was performed. Primary outcome was any complication requiring intervention. Secondary outcomes were minor complications, operative time, length of stay, conversion and readmission. Results 170 patients were operated on. Indications were biliary colic in 127 (74.7%), cholecystitis 30 (17.6%) and pancreatitis in 13(7.6%). Mean operating time was 65 minutes (Range 35-152). 53 operations were assisted by a consultant, 110 by a senior SAS grade and 7 by a CT2. 139 (81.7%) patients were discharged on the day of surgery. 24 (14.1%) stayed one night in hospital. There were no major complications. Four patients required readmission. Two with pain and 2 with port site infections. There were no conversions or transfusions required. Conclusion There is a paucity of published data on surgical outcomes of procedures performed by SCPs. With a structured, supervised approach SCPs could be trained to take on more complex procedures and further strengthen the surgical workforce. This study demonstrates that elective LC can be safely performed by an appropriately trained and supervised SCP.

Remote monitoring after elective colorectal surgery, a pilot study

BackgroundMultiple studies have demonstrated safety of short stay after colorectal resections. Remote patient monitoring may allow earlier discharge home after surgery. Remote patient monitoring feasibility after elective colorectal surgery in a largely rural state was evaluated. MethodsA pilot study was undertaken May-August 2023 for patients >18 years of age, fluent in English, with compensated medical morbidities who underwent elective minimally invasive colorectal surgery. Patients were monitored at home with pulse oximetry, heart rate, blood pressure, and weight for 2 weeks. A remote nurse assessed and escalated to the colorectal surgery department as needed. Patients answered daily surveys on pain, ostomy/incision, bowel function, and oral intake. Patient satisfaction was surveyed on days 5 and 12 using a 5-point Likert scale. ResultsSixteen patients undergoing laparoscopic colorectal surgery were enrolled preoperatively. The average length of stay was 3.0 days (1–9), 43% for malignancy, and 25% for inflammatory bowel disease. In 25% of cases, conversion to open surgery was required. The average home monitoring system set-up time was 53 minutes. Two patients were noncompliant. A third patient had a late loss of digital services. The remote nurse detected 2 complications: port site infection and delayed ileus. One required readmission. Patient satisfaction scores were high for the entire study period. Operation by third party failed in all attempted cases. ConclusionRemote home monitoring is a safe, feasible, and well-liked option for patients undergoing minimally invasive colorectal surgery in rural areas. Complex disease, compensated morbidities, and conversion to open surgery were not contraindications to early discharge.

Modified Open Technique for First Port Insertion in Laparoscopic Surgery

Laparoscopy has become the method of excellence for abdominal surgeries in modern age. The significance of a secure and dependable approach for the initial trocar insertion cannot be overstated in this surgical procedure. Our preferred method involves employing a modified open technique to access the peritoneal cavity. This study was conducted to evaluate the laparoscopic surgery of modified open technique. This cross sectional follow-up study was conducted in the Department of General Surgery Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from January 2019 to December 2022. The umbilicus was everted to make it tubular, an infra-umbilical incision was given to cut the linea alba for making an opening and advanced bluntly to introduce the first port. A total of 197 patients were studied after completion of surgery. Cholecystectomy was the most common surgical indication. The mean entry time was 3.1±0.6 minutes. Regarding the postoperative complication port site infection was 2.03% and port site hernia was 1%. There was no incidence of pre-peritoneal placement of port, port site seroma, haematoma. No mortality was found during the hospital stay of patients. Modified open technique is a quick and safe procedure for insertion of the first port in laparoscopic surgery. Bangladesh Med J. 2023 May; 52(2): 11-14

The Outcome of the Laparoscopic Hysterectomy in Al-Yarmouk Teaching Hospital in 2022–2023

Abstract Background: Hysterectomy is a common gynecological procedure used for various benign conditions like abnormal uterine bleeding, uterine prolapse, and fibroids. Different surgical methods, including vaginal, abdominal, laparoscopic, and robotic-assisted approaches, offer unique advantages and disadvantages. Total laparoscopic hysterectomy (TLH), introduced in 1989, offers benefits like smaller incisions, less blood loss, reduced pain, shorter hospital stays, and faster recovery. Objectives: The objective of this study was to evaluate patient outcomes, complications, and satisfaction with laparoscopic hysterectomy surgery. Patients and Methods: This cross-sectional study was conducted in Al-Yarmouk Teaching Hospital in Baghdad, General Surgery Department, from August 2022 to August 2023. Twenty-five patients who underwent laparoscopic hysterectomy for benign conditions were included. Patients were carefully assessed, ruling out malignancies through extensive clinical and radiological examinations, ultimately qualifying for the procedure. Data on patients’ demographics, comorbidities, previous surgical history, uterine size, indication for hysterectomy, type of procedures performed, and postoperative complications were gathered and subjected to analysis. The follow-up duration extended over 3 months, with assessments done on the 3rd day, 10th day, 1st month, and 3rd month postsurgery. Results: The mean age was 51.52 ± 9.47 years. Dysfunctional uterine bleeding was the most common indication (44%), followed by postmenopausal bleeding (32%). Most patients underwent TLH with bilateral salpingo-oophorectomy (BSO) (68%), and the mean operative time was 110 min. Complications were observed in 10 (40%) cases, with common issues being blood transfusion, port-site infection, and bladder injury. Hospitalization lasted 2 days, and postoperative pain reduced gradually over time. Patients who underwent concomitant BSO had significantly higher complications than those with isolated TLH. Postoperative pain levels were comparable between the two groups. Conclusion: Laparoscopic hysterectomy is an effective option for treating benign gynecological conditions, offering benefits like improved postoperative pain control and shorter hospital stays. However, the potential for complications, particularly in cases involving additional procedures, is to be considered.

Complications in single-incision laparoscopic surgery transabdominal preperitoneal (SILS-TAPP) for inguinal hernia

Objective: Single-incision laparoscopic surgery transabdominal preperitoneal (SILS-TAPP) inguinal hernia (IH) repair represents an innovative advancement in minimally invasive surgical techniques. However, there have been concerns about the complication rate of this technique. We aimed to systematically review the complications of SILS-TAPP in detail. Methods: We comprehensively searched the published literature between 1980 and 2022 on Pubmed, Embase, Scopus, Web of Science, and Proquest. Studies of IH patients aged < 18 who underwent SILS-TAPP were included. The results must include the intraoperative and/or postoperative complications rate of surgery. Studies not in English, studies of patients who underwent another surgery apart from hernia repair, and review articles were excluded. The abstract and full-text screening were done. Results: Primary search on a major database platform gained 348 records of articles. After screening, 9 studies were included. Nine studies recruited 1561 patients. Men were dominant. Recurrent IH accounted for about 4%. Two studies reported using specialized laparoscopic instruments (Roticulator), while the other eight used conventional instruments. No major intraoperative complications were reported. Blood loss was minimal. There was only one case wherein an additional trocar was placed. Postoperative complications were observed in about 5% of cases, including seroma, hematoma, urinary retention, port site infection, ileus, foreign body sensation, and port site hernia. Recurrence was rare, accounting for about 0.3%. Conclusion: Complications of SILS-TAPP are not frequent and mild. The recurrent rate is small. Therefore, SILS-TAPP can be a good alternative for open and laparoscopic hernia repair.

Insights Into Laparoscopic Port Site Complications: A Comprehensive Review.

Laparoscopic surgery has become a widely accepted standard of care for numerous procedures in the modern world. Nearly every major surgical procedure previously only possible by employing open techniques may now be completed laparoscopically, attributable to the quick advancement of technology and surgeons' abilities. There are several complications associated with the laparoscopic port site, either infective, non-infective, or neoplastic. This study aims to explore the morbidity associated with the port site following laparoscopic surgery and discuss the risk factors for complications. The umbilical port was most frequently associated with port-site hernia (PSH), followed by the epigastrium and the left and right hypochondrium. Prolonged port manipulation and reinsertion, longer surgical times, failure to effectively close the fascial defect, and wound infection are responsible for the development of PSH. Port-site infection (PSI) is one avoidable adverse effect of laparoscopic surgery. Patients who have a history of diabetes, malnourishment, prolonged preoperative hospital stays, preoperative Staphylococcus aureus colonization of the nares, perioperative blood transfusions, and tobacco or steroid use are more likely to have PSI. Port-site hydatid cyst (PSHC) and port-site tuberculosis (PST) are rare but possible. While uncommon, a doctor should rule out endometriosis if a painful mass in the surgical scar, such as the trocar site, is discovered in a reproductive-age woman who has had pelvic or obstetric surgery in the past. Port-site metastasis (PSM) is the term for tumor-cell implantation at the trocar insertion site after a malignant tumor is removed laparoscopically. PSM has been reported in 1-2% of laparoscopic gynecologic surgical procedures. A few potential mechanisms for cell implantation at the port site include embolization of exfoliated cells during tumor dissection or hematogenous spread, air turbulence during long laparoscopic operations, and direct implantation onto the wound during forced, unprotected organ/tissue retrieval or from contaminated surgical instruments during tumor dissection. Nonetheless, the triggering mechanism is likely essentially multifaceted.Prevention is better than cure. Port-site hernia can be prevented using smaller trocars and meticulous rectus sheath defect closure at the end of surgery. The rest of the port site complications can be prevented by employing autoclavable laparoscopic hand instruments, utilizing autoclaved water to clean the instruments following disassembly, adhering to the recommended concentration, contact duration, and usage cycles when sterilizing instruments with liquid sterilizers, preventing bile or gut content from spilling into the operating room or the port site, using non-porous specimen retrieval bags for recovering the specimen, and thoroughly cleaning and irrigating the port site before closing the wound.

Bacterial Colonization on Endoscopic Materials and Surgical Field Without Infections After Transoral Endoscopic Thyroidectomy.

Our aim was to determine whether bacteria contamination occurred within the surgical field or on endoscopic equipment during surgery using the transoral endoscopic thyroidectomy vestibular approach (TOETVA). Participants were recruited from patients planned for TOETVA between May 2017 and December 2019. Bacterial samples were taken before and at the conclusion of the TOETVA procedure. The preoperative and postoperative samples were taken from the endoscopic materials and inferior oral vestibulum using a sterile flocked swab. The study resulted in 480 samples (80 TOETVAs). No vestibular, port site, or neck infections occurred in any of the patients. Three (3.7%) out of 80 patients developed postoperative fever. Our results show different microbial communities during TOETVA. The most prevalent species detected were S treptococcus species. Multivariate logistic regression analyses revealed that the degree of contamination depended on the sampling site (inferior vestibulum > equipment) ( P =0.03). In addition, the abundance of bacteria was affected by operative time ( P =0.013). There were no significant differences observed in isolation frequencies of bacteria in malignancy ( P =0.34). TOETVA surgery is categorized as a "clean-contaminated" operation. A swab identified the common colonizers of oral microbiota on the endoscopic equipment and within the surgical field.

SAFETY AND FEASIBILITY OF THE THREE PORT TECHNIQUE FOR CONCOMITANT CHOLECYSTECTOMY DURING SLEEVE GASTRECTOMY: A COMPREHENSIVE ANALYSIS AND CLINICAL IMPLICATIONS

Introduction:Obesity, a prevalent global health issue, has led to an increased demand for bariatric surgeries, with laparoscopic sleeve gastrectomy (LSG) being a preferred option due to its efficacy and minimal invasiveness. Concomitant cholecystectomy (CC) during LSG has gained traction among patients with obesity and gallstones. While various techniques have been explored, concerns persist regarding safety and efficacy. Our study aims to evaluate the feasibility and outcomes of a three-port laparoscopic technique for this combined procedure. Methodology:Ahigh-volume bariatric center in Saudi Arabia conducted a retrospective cohort study involving patients who underwent three-port sleeve gastrectomy (3PSG) with CC between January 2022 and January 2024. We collected and analyzed data on demographics, preoperative evaluation, intraoperative details, and postoperative outcomes using descriptive statistics. Results:Out of 360 LSG patients, 76 underwent CC with the three-port technique. The mean age was 42.18 years, with a female predominance (71.0%) and a mean BMI of 44.67 kg/m2. Intraoperatively, the mean operative time was 109.8 minutes, with minimal blood loss and no complications or conversions to open surgery. The average hospital stay was 2.1 days. Postoperatively, the complication rate was 4%, primarily consisting of early bleeding, port-site infection, and atelectasis, all of which were managed conservatively. No severe complications, mortalities, or thrombotic events occurred during the 3-month follow-up. Conclusion:Thethree-port laparoscopic technique for concomitant cholecystectomy during sleeve gastrectomy appears safe and feasible, offering favorable outcomes in terms of operative time, blood loss, and postoperative complications. This approach presents a promising option for minimizing surgical trauma and enhancing recovery in obese patients who require both procedures.

FREQUENCY OF PORT SITE WOUND INFECTION AFTER GALL BLADDER REMOVAL WITH AND WITHOUT RETRIEVAL BAG IN LAPAROSCOPIC CHOLECYSTECTOMY

Cholecystectomy is the preferred therapy for symptomatic gallstones, which involves removing the organ implicated in the development of gallstones and the difficulties that arise from them. This research was conducted to examine the incidence of port site infection between patients having laparoscopic cholecystectomy with and without retrieval bags. Objective: To compare the frequency of port site wound infection after gall bladder removal with and without retrieval bag in laparoscopic cholecystectomy. Methods: This Randomized Controlled Trial was carried out at the General Surgical Department of Allama Iqbal Teaching Hospital, Dera Ghazi Khan. The study duration was six months, from June 2022 to December 2022. One hundred patients in total were recruited and divided into two groups. In Group A, after a laparoscopic cholecystectomy, the laparoscope was inserted via the epigastric port site, and a retrieval bag was used to insert the bag through the umbilical port site. The laparoscope was moved to the epigastric port in Group B, where the gall bladder was removed without a retrieval bag. Patients in this group were monitored for a month to look for post-operative port site infections. Results: In the current study, 100 cases were enrolled. Of the male patients, 44 (44%) and 56 (56%) were female. The mean age of our study cases was 31.77 ± 2.86 years. Of these 100 study cases, 33 (33%) had ASA grade I, and 67 (67%) had ASA grade II. Port site infection was present in 7(7%) of our study cases. Port site infection in group A was present in 4 %, while in group B was 10 %. (p = 0.436). Conclusion: Laparoscopic cholecystectomy using a retrieval bag for removal of the gallbladder is “quite safe, reliable and effective procedure” as the frequency of port site infection was low in our study cases. Port site infection was more frequent in patients undergoing laparoscopic cholecystectomy without retrieval bags as compared with those with retrieval bags. However, this difference was not statistically significant.

Laparoscopic cholecystectomy performed by a surgical care practitioner: a review of outcomes.

Surgical care practitioners (SCPs) are non-medical workers involved in various aspects of the management of surgical patients. The role includes assisting and performing surgical procedures. More than 60,000 laparoscopic cholecystectomies (LC) are performed annually in the UK. With ever-increasing pressure on waiting lists, it is important to look at fully utilising the skills of our entire workforce. We report what we believe is the first published series of LC performed by an SCP. A retrospective review of a prospectively collected database was performed. The primary outcome was any complication requiring intervention. Secondary outcomes were minor complications, operative time, length of stay, conversion and readmission. In total, 170 patients were operated on. Indications were biliary colic in 127 (74.7%), cholecystitis in 30 (17.6%) and pancreatitis in 13 (7.6%). Mean operating time was 65min (range 35-152min). Fifty-three operations were assisted by a consultant, 110 by a specialist or associate specialist grade (SAS) doctor and 7 by a core trainee (CT2). Some 139 (81.7%) patients were discharged on the day of surgery and 24 (14.1%) stayed one night in hospital. There were no major complications. Five patients required readmission, three with pain and two with port site infections. There were no conversions or transfusions required. There is a paucity of published data on surgical outcomes of procedures performed by SCPs. With a structured, supervised approach, SCPs could be trained to take on more complex procedures and further strengthen the surgical workforce. This study demonstrates that elective LC can be safely performed by an appropriately trained and supervised SCP.

An Observational Study on Port-site Infection and its Management in Patients Undergoing Laparoscopic Cholecystectomy

Background: With increasing number of performed laparoscopic cholecystectomies, there is an increasing number ,of port site infection, although it occurs infrequently, but it has significant influence on overall outcomes of laparoscopic cholecystectomy. The aims of the present study was to identify the causative organism involved in port-site infection (PSI) and its management and outcome after laparoscopic cholecystectomy objectives and to evaluate causative organism involved in port site infection after laparoscopic cholecystectomy.Materials & Methods: Patients who underwent laparoscopic cholecystectomy and now presenting with PSIin General Surgery OPD and Emergency of Burdwan Medical College and Hospital. Thorough clinical historytaking followed by swabs was taken for culture and sensitivity in all patients who developed port site infection after laparoscopic cholecystectomy. Tissue samples were taken for detection of mycobacterium tuberculosis by CBNAAT. All patients were followed up for 6 months post operatively. Incidence of PSI in relation to gender, pre-operative diagnosis, spillage, relation with different port sites and the type of microorganism associated was evaluated and compared with previous study.Results: In the present study 90 patients who underwent laparoscopic cholecystectomy, 19 patients reported port site infection after surgery, whereas the remaining 71 patients had uneventful post operative period. Out of the 19 infected 7 were male [25% of total male cases] and 12 were female [19% of total female cases]. Cases of port site infection were 21% of total cases. Conclusion: The incidence of PSI was higher in cases of acutely inflamed GB, biliary spillage, open port creation, avoidance of endo-bag, and in comorbidities. They were managed with either antibiotics, dressing or surgical exploration.

Laparoscopic Port Site Infection: A Review of Its Management of 100 Cases Studies

Introduction: The advent of laparoscopic surgery has transformed the landscape of surgical interventions, providing patients with the benefits of reduced trauma, shorter recovery times, and improved cosmetic outcomes. As this minimally invasive approach continues to gain popularity across various surgical disciplines, it is essential to address the associated challenges and complications that may arise. Aim of the Study: The aim of this study was to analyze the microbial distribution and antibiotic sensitivity patterns in laparoscopic port site infections. Methods: A prospective observational study was conducted on a cohort of 100 patients who underwent laparoscopic procedures at MH Samorita Medical College & Hospital, Hi Tech Surgicare Hospital & piles Centre, Savar Specialized Hospital, Lab Zone Hospital Savar, Dhaka, Bangladesh from Jan 2016 to Dec 2023. The study focused on identifying cases with culture-positive laparoscopic port site infections. Result: The Laparoscopic cholecystectomy being analyzed by Cholelithiasis, Acute cholecystitis, Ch. Cal. Cholecystitis, Empyema GB, and GB polyp. For Cholelithiasis, 33.3% of males and 40.5% of females had this condition. Regarding Acute cholecystitis, it was found in 20.0% of males and 16.7% of females. Majority 36.7% were 40 – 50 years in age group for male and 30.9% were in 40 – 50 years in age group for female respectively. Out of the total 100 patients in the study, 71% patients tested positive for port site infection. Conclusion: In conclusion, the insights gained from our study provide a foundation for advancing the management of laparoscopic port site infections.

Hand Assisted versus Intracorporeal Ligation of Appendicular Base During Laparoscopic Appendicectomy

Background: Laparoscopic appendicectomy is one of the most common operations in surgical practice. It can be performed by open and laparoscopic methods. Laparoscopic appendicectomy have the advantage of less pain time and early return to work. The current work aimed to evaluate the safety, and effectiveness of intracorneal ligation versus extraction of the appendicular base during laparoscopic appendectomy.
 Patients and methods: This clinical trial involved 40 patients with acute appendicitis. They were selected from the surgery department, Al-Azhar Faculty of Medicine, Damietta, Egypt. They were scheduled for laparoscopic appendectomy and randomized to one of two groups; the first (A) for intracorporeal ligation of the based and the second (B) for hand assisted ligation of the stump. The collected data included operative time, postoperative outcome (duration of stay, back to usual oral feeding and postoperative complications (e.g., wound infection or leakage)). 
 Results: Male patients were slightly predominating in both groups. The hand assisted ligation of appendicular stump had significantly shorter operative time (34.4±3.05 vs 42.95±8.21 minutes respectively). However, there was no significant differences in both groups regarding post operative complication, except significant increase of port-site infection in hand assisted than the intracorporeal group (45.0% vs 10.0%) which was mild and treated conservatively. No leakage was reported in both groups.
 Conclusion: Hand assisted ligation of appendicular base during laparoscopic appendicectomy is safe and effective method with shorter operative time. It encourages the surgeon to do more complex procedures