Terms Of Surgical Site Infection Research Articles

Comparison of Skin Staples versus Skin Sutures After Inguinal Hernioplasty in Terms of Surgical Site Infection

Background: Surgical site infection is a major concern following inguinal hernia repair, potentially leading to extended hospital stays, increased morbidity, patient discomfort, and higher healthcare costs. This study aimed to conduct a comparative analysis between skin staples and skin sutures in inguinal hernioplasty, explicitly focusing on their impact on surgical site infection rates. Methods: From September 2022 to June 2023, a randomized control trial study was carried out at the Surgery Department, Kulsoom Bai Valika Hospital Karachi. A total of 100 patients who underwent Lichtenstein tension-free mesh hernioplasty were allocated into two groups: the stapler group (n=50) and the polypropylene suture group (n=50). The patients were monitored for 3 to 6 hours post-surgery and safely discharged on the first postoperative day. Follow-up was scheduled 7 days after surgery to assess wound complications, specifically surgical site infections. Comparison between both groups was done using the Chi-square/Fisher exact test for surgical site infection and independent samples t-test for pain score. The level of significance was set at 5%. Results: The incidence of postoperative pain was slightly lower in the stapler group compared to the suture group (10% vs. 16%), this difference was not statistically significant (p=0.544). Moreover, the surgical site infection rate was significantly lower in the stapler group (3%) than in the suture group (12%) with p=0.012. Conclusion: When securing the mesh in inguinal hernia cases, the utilization of skin staples was considered a safe approach and was associated with lower surgical site infection as compared to skin sutures.

SP9.6 Effectiveness and safety of prophylactic mesh closure in emergency Gastrointestinal surgery

Abstract Background Wound complications are frequent in emergency Gastro-Intestinal (GI) surgery increasing morbidity and cost of care. Although laparotomy closure using a prophylactic mesh has been proven to limit Incisional Hernia (IH) occurrence, the literature lacked a high-quality assessment in the setting of emergency GI laparotomy. This review offers an up-to-date evaluation of the prophylactic mesh closure in these conditions. Methods A systematic review was executed via literature database: PubMed, Cochrane database, Science Direct and Google Scholar. Studies were examined for eligibility and included if they managed to compare prophylactic mesh closure to the conventional laparotomy closure in GI emergency surgeries. Both early postoperative fascial dehiscence and late incisional hernia were examined as primary endpoints. Secondary outcomes incorporate Surgical Site Infection (SSI), seroma/hematoma formation, complications of Clavien-Dindo score ≥3, operative time, and hospital stay. Results 2 Randomised controlled trials (RCTs)(1, 2) and 2 comparative studies,(3, 4) which studied 562 patients, met the inclusion criteria. The hernia rate was significantly reduced in the mesh group (Odds Ratio 0.14 [0.05, 0.36], P value < 0.0001), while there was no statistically significant difference in fascial dehiscence between the studied groups (Odds Ratio 0.49 [0.01, 47.02], P value= 0.76). In addition, there was no significant outcome favouring one group over the other in terms of SSI and rest of the screened endpoints. Conclusion Despite the promising reduction in IH rate, a solid outcome was not obtained due to the limited number of relevant studies, paucity of RCTs and diversity in surgical techniques and mesh positions. A wider-scale RCTs may offer reliable results.

The Efficacy of Daily Local Antibiotic Lavage via an Epidural Suction-Irrigation Drainage Technique in Spondylodiscitis and Isolated Spinal Epidural Empyema: A 20-Year Experience of a Single Spine Center.

Various treatment modalities are available for local antibiotic therapy in spondylodiscitis (SD) and isolated spinal epidural empyema (ISEE), but there is no evidence-based recommendation. Postoperative epidural suction-irrigation drainage (ESID) is thought to reduce bacterial load, which may prevent the development of relapse, wound healing, hematogenous spread, and systemic complications. We evaluated the efficacy of postoperative ESID over 20 years on disease progression and outcome in SD and ISEE. Detailed demographic, clinical, imaging, laboratory, and microbiological characteristics were examined in our cohorts of 208 SD and ISEE patients treated with and without ESID at a university spine center in Germany between 2002 and 2022. Between-group comparisons were performed to identify meaningful differences for the procedure. We included data from 208 patients (142 SD, 68.3% vs. 66 ISEE, 31.7%) of whom 146 were ESID patients (87 SD, 59.6% vs. 59 ISEE, 40.4%) and 62 were NON-ESID patients (55 SD, 88.7% vs. 7 ISEE, 11.3%). ESID patients with SD showed more frequent SSI (ESID: 22, 25.3% vs. NON-ESID: 3, 5.5%, p = 0.003), reoperations due to empyema persistence or instability (ESID: 37, 42.5% vs. NON-ESID: 12, 21.8%, p = 0.012), and a higher relapse rate (ESID: 21, 37.5% vs. NON-ESID: 6, 16.7%, p = 0.037) than NON-ESID patients with SD. The success rate in NON-ESID patients with SD was higher than in ESID patients with SD (ESID: 26, 29.9% vs. NON-ESID: 36, 65.6%, p < 0.001). Multivariate binary logistic regression analysis showed that ESID therapy (p < 0.001; OR: 0.201; 95% CI: 0.089-0.451) was a significant independent risk factor for treatment failure in patients with SD. Our retrospective cohort study with more than 20 years of experience in ESID technique shows a negative effect in patients with SD in terms of surgical site infections and relapse rate.

Clinical Effects of Tourniquet Use for Nontraumatic Major Lower Limb Amputation: A Two-Center Retrospective Cohort Study

To investigate the effect of tourniquet use on outcomes after major lower limb amputation (MLLA) due to peripheral arterial disease or complications from diabetes mellitus. In this 2-center retrospective observational study, vascular patients who underwent MLLA between January 1, 2016 and December 31, 2020 at 2 UK hospitals were identified using operating theater databases. Hospital databases were used to access medical records, operation notes, and laboratory reports. The use of a tourniquet in each MLLA was noted. The primary outcome was postoperative hemoglobin (Hb) drop (g/L). Secondary outcomes were units of allogeneic blood transfused perioperatively, 90-day revision rates, 90-day wound breakdown rates, surgical site infection (SSI) rates (at 30days), and 90-day mortality. A follow-up index (a measure of follow-up completeness) was calculated for all 30-day and 90-day outcomes. Four hundred seventy two patients underwent MLLA, of which 124 had a tourniquet applied. The median postoperative Hb drop was significantly lower in the tourniquet group compared to the nontourniquet group (13 [interquartile range 5-22] g/L vs. 20 [interquartile range 11-28] g/L; P ≤ 0.001). Thirty three point one percent (41) of tourniquet patients received a blood transfusion perioperatively, compared to 35.6% (124) of nontourniquet patients (P=0.82). Sixteen percent (76) of patients required surgical revision within 90days, with no significant difference between the tourniquet and nontourniquet group (20.2% tourniquet vs. 14.7% no tourniquet; P=0.15). SSI rates (12.0% tourniquet vs. 10.6% no tourniquet, P=0.66) and 90-day mortality (6.5% tourniquet vs. 10.1% no tourniquet; P=0.23) were similar. Multivariable regression demonstrated that tourniquet use was independently associated with a reduced hemoglobin drop (β=-4.671, 95% confidence interval -7.51 to -1.83, P ≤ 0.001) but was not associated with wound breakdown, revision surgery, or SSI. Hypertension, SSI, and below-knee amputation using the skew flap technique were all significant predictors of revision surgery. All follow-up indices were ≥ 0.97. Tourniquet use in MLLA was associated with a significantly lower fall in postoperative Hb without evidence of harm in terms of SSI, wound breakdown/revision rates, or mortality.

Comparison of High Ligation Versus Low Ligation of the Inferior Mesenteric Artery (IMA) on Short-Term and Long-Term Outcomes in Sigmoid Colon and Rectal Cancer Surgery: A Meta-analysis.

This study was done to compare the perioperative outcomes and long-term outcomes between low ligation and high ligation of the inferior mesentric artery (IMA) in sigmoid colon and rectal cancer surgery.This study was conducted following the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). A literature search was performed in electronic databases including PubMed, CINAHIL, EMBASE, and Web of Science to identify studies published between January 1, 2015, and April 30, 2023.The outcomes assessed in this meta-analysis included postoperative complications (anastomotic leakage, surgical site infection, and postoperative ileus), intraoperative outcomes (duration of surgery in minutes, total intraoperative blood loss in milliliters, total lymph nodes harvested, and total number of metastatic lymph nodes), recovery outcomes (time to first flatus and length of hospital stay), and long-term outcomes (five-year mortality rate and disease-free survival rate).A total of 17 studies were included in this meta-analysis. Of these, six were randomized control trials (RCTs) and 11 were retrospective cohort studies. This meta-analysis suggests that lower ligation may be associated with a lower risk of anastomotic leakage compared to higher ligation in patients undergoing colon cancer surgery. However, there was no significant difference between the two techniques in terms of surgical site infection, postoperative ileus, total lymph nodes harvested, number of metastatic lymph nodes, duration of surgery, intraoperative blood loss, and length of hospital stay. Time to first flatus was significantly shorter in patients who underwent lower ligation. Additionally, there were no significant differences in the five-year mortality rate and disease-free survival rate between the two techniques. The results of this study indicate that both techniques are comparable in most aspects and suggest that the choice of technique should be based on individual patient factors and surgeon preference.

A Meta-Analysis of 80% Fraction of Inspired Oxygen on Surgical Site Infection in Patients Undergoing Surgery

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; WHO recommended the use of 80% FiO&lt;sub&gt;2&lt;/sub&gt; in patients undergoing general anesthesia with endotracheal intubation (ETI) to prevent surgical site infection (SSI). However, the ongoing debate regarding efficacy and safety raises because further trials have been published. We conducted a review based on recommendations in terms of SSI as the primary outcome and adverse events as the secondary outcome in both patients with or without ETI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method:&lt;/strong&gt; A literature search was carried out by PubMed, ScienceDirect, and Google Scholar for RCTs in all-type surgical patients who administrated 80% FiO&lt;sub&gt;2&lt;/sub&gt; compared with 30–35% FiO&lt;sub&gt;2&lt;/sub&gt;. Pooled relative risks with a 95% confidence interval were conducted for meta-analysis. &lt;strong&gt;Result:&lt;/strong&gt; Based on 23 RCTs included in the analysis, there were no significant differences in terms of SSI (RR,0.85; 95%CI, 0.72 to 1.01; p=0.07), sepsis (RR,1.47; 95%CI, 0.78 to 2.76; p=0.23), postoperative hospitalization days (PHD) (RR,0.16; 95%CI, -0.67 to 0.98; p=0.71), ICU admission (RR,0.94; 95%CI, 0.78 to 1.13; p=0.50), reoperation required (RR,0.78; 95%CI, 0.30 to 2.06; p=0.62), and 30-days mortality (RR,1.18; 95%CI, 0.76 to 1.84; p=0.45). In contrast, even though the subgroup analysis showed association that PHD longer in high FiO&lt;sub&gt;2&lt;/sub&gt; group for colorectal surgery (RR,0.80; 95%CI, 0.24 to 1.35; p=0.005), the high FiO&lt;sub&gt;2&lt;/sub&gt; significantly reduced SSI and anastomotic leakage in abdominal surgery (RR,0.78; 95%CI, 0.62 to 0.99; p=0.04 and RR,0.55; 95%CI, 0.36 to 0.85; p=0.008).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; This meta-analysis provides evidence that administration of 80% FiO&lt;sub&gt;2&lt;/sub&gt; even though association with longer of PHD in colorectal surgery, it is associated with a reduction in SSI and anastomotic leakage in patients who underwent abdominal surgery. It contrasts for sepsis, ICU admission, reoperation required, 30-day mortality, SSI, and PHD in all-type surgery. &lt;/p&gt;

Synthetic mesh versus biological mesh to prevent incisional hernia after loop-ileostomy closure: a randomized feasibility trial

BackgroundIncisional hernia is a frequent complication after loop-ileostomy closure, rationalizing hernia prevention. Biological meshes have been widely used in contaminated surgical sites instead of synthetic meshes in fear of mesh related complications. However, previous studies on meshes does not support this practice. The aim of Preloop trial was to study the safety and efficacy of synthetic mesh compared to a biological mesh in incisional hernia prevention after loop-ileostomy closure.MethodsThe Preloop randomized, feasibility trial was conducted from April 2018 until November 2021 in four hospitals in Finland. The trial enrolled 102 patients with temporary loop-ileostomy after anterior resection for rectal cancer. The study patients were randomized 1:1 to receive either a light-weight synthetic polypropylene mesh (Parietene Macro™, Medtronic) (SM) or a biological mesh (Permacol™, Medtronic) (BM) to the retrorectus space at ileostomy closure. The primary end points were rate of surgical site infections (SSI) at 30-day follow-up and incisional hernia rate during 10 months’ follow-up period.ResultsOf 102 patients randomized, 97 received the intended allocation. At 30-day follow-up, 94 (97%) patients were evaluated. In the SM group, 1/46 (2%) had SSI. Uneventful recovery was reported in 38/46 (86%) in SM group. In the BM group, 2/48 (4%) had SSI (p > 0.90) and in 43/48 (90%) uneventful recovery was reported. The mesh was removed from one patient in both groups (p > 0.90).ConclusionsBoth a synthetic mesh and biological mesh were safe in terms of SSI after loop-ileostomy closure. Hernia prevention efficacy will be published after the study patients have completed the 10 months’ follow-up.

INCIDENCE OF SURGICAL SITE INFECTION/ WOUND GAPING IN SUTURED VS STAPLED CLOSURE OF ABDOMINAL INCISION: A COMPARATIVE STUDY

Background Surgical wound is any wound inicted during surgical process and infection of surgical wound is a relevant complication with an incidence of 1% to 3%. Many factors are responsible for the occurrence of surgical site infections, like age, presence of comorbidities, type of procedure, wound closure method, level of contamination etc. Surgical Site Infection or SSI is associated with a signicant economic burden in terms of extended length of stay and increased costs of treatment. Objectives- To determine whether the incidence of surgical site infections differed after wound closure with non-absorbable suture material vs skin stapler, in elective abdominal surgeries. Methods- A comparative study to determine the incidence of surgical site infections after elective abdominal surgery was conducted in a tertiary care setup for a duration of one year. The study population was divided by random computer method in two arms, consisting of 30 patients each. In one arm the abdominal wound after elective surgery was closed with non-absorbable sutures while in the other with skin staplers. Outcomes were noted in terms of Surgical site infection, i.e, presence of wound gape, burst abdomen, closure duration, duration of hospital stay and interventions like secondary suturing, daily cleaning and dressing (CnD) Results- A total of 60 patients who underwent elective abdominal surgeries were divided into two arms of 30 patients each. Wound closure in one group done by non-absorbable suture material while in the other group with skin stapler. The groups were comparable in demographics, ASA (American society of Anaesthesiologist) grading and CDC (Centre for disease control) class of surgical wound. In our study, Surgical site infections were detected in 33.3 % (10 patients) in the sutured arm of closure of abdominal incision, while SSI were detected in 26.6 % (8 patients) of stapled arm of closure of abdominal incision. No signicant difference encountered in the incidence of SSI in sutured and stapled closure of abdominal wound. 76.7% (23 patients) underwent wound closure within 10 minutes in the stapled arm, while only 20 % (6 patients) in the sutured arm had surgical time duration of wound closure less than 10 minutes (p value &lt; 0.001), the wound closure duration in the stapled arm was signicantly less compared to the sutured arm. Conclusions- There was no signicant difference in the incidence of surgical site infections in both the groups, but the surgical time duration of wound closure was signicantly lower in the stapled group.

Comparison of Prophylactic Versus Regular Use of Antibiotics in C-Section

Objective: The purpose of this study is to compare the effectiveness of prophylactic versus regular use of antibiotics. Study Design: Randomized Control Trial Place and Duration: In the department of Gynaecology and Obstetrics, Combined Military Hospital, Peshawar for the duration from January 2021 to December 2021. Methods: Total 116 pregnant women had age 20-48 years were included. All the patients were admitted to hospital and underwent for c-section. We have taken informed written consent of all females for detailed demographics included age, BMI, gestational age and parity. Patients were equally divided in two different groups. Group I received prophylactic antibiotic (Cefazolin 1g) and group II received cefuroxime 750 mg. Post-operatively outcomes were compared in terms of surgical site infection, hospitalization and other adverse events among both groups. SPSS 20.0 was used to analyze all data. Results: Among 116 cases, 58 (50%) females had age 20-30 years, 39 (33.6%) were aged between 31-40 years and 19 (16.4%) had age 41-48 years. 70 (60.3%) cases had BMI &gt;25kg/m2 and 46 (39.7%) had BMI &lt;25kg/m2. Majority of the cases 67 (57.8%) were emergency c-sections and 49 (42.2%) were elective cases. Mean gestational age of the females in group I was 37.2±11.91 weeks and in group II was 36.11±8.45 weeks. Mean parity in group I was 2.7±4.13 and in group II was 1.9±6.8.We found that frequency of SSI was lower in group I 3 (5.2%) as compared to group II in 7 (12.1%). Mean hospitalization in group I was lower 3.6±4.16 days as compared to group II 7.5±6.17 days. Febrile illness and endometritis was also higher in group II with p value &lt;0.04. Conclusion: We concluded in this study that prophylactic antibiotic was affective and useful among patients undergoing c-section in terms of minimum SSI, hospital stay and adverse events as compared to regular antibiotics. Keywords: C-section, Prophylactic, Antibiotics, Adverse Events

Analysis of PMMA versus CaP titanium-enhanced implants for cranioplasty after decompressive craniectomy: a retrospective observational cohort study

Numerous materials of implants used for cranioplasty after decompressive craniectomy (DC) have been investigated to meet certain demanded key features, such as stability, applicability, and biocompatibility. We aimed to evaluate the feasibility and safety of biocompatible calcium-phosphate (CaP) implants for cranioplasty compared to polymethylmethacrylate (PMMA) implants. In this retrospective observational cohort study, the medical records of all patients who underwent cranioplasty between January 1st, 2015, and January 1st, 2022, were reviewed. Demographic, clinical, and diagnostic data were collected. Eighty-two consecutive patients with a mean age of 52 years (range 22–72 years) who received either a PMMA (43/82; 52.4%) or CaP (39/82; 47.6%) cranial implant after DC were included in the study. Indications for DC were equally distributed in both groups. Time from DC to cranioplasty was 143.8 ± 17.5 days (PMMA) versus 98.5 ± 10.4 days (CaP). The mean follow-up period was 34.9 ± 27.1 months. Postoperative complications occurred in 13 patients with PMMA and 6 in those with CaP implants (13/43 [30.2%] vs. 6/39 [15.4%]; p = 0.115). Revision surgery with implant removal was necessary for 9 PMMA patients and in 1 with a CaP implant (9/43 [20.9%] vs. 1/39 [2.6%]; p = 0.0336); 6 PMMA implants were removed due to surgical site infection (SSI) (PMMA 6/43 [14%] vs. CaP 0/39 [0%]; p = 0.012). In this study, a biocompatible CaP implant seems to be superior to a PMMA implant in terms of SSI and postoperative complications. The absence of SSI supports the idea of the biocompatible implant material with its ability for osseointegration.

Comparison of Laparoscopic and Open Appendectomy in Terms of Surgical Site Infection

Objective: To compare the laparoscopic and open appendectomy in terms of surgical site infection. Study Design: Retrospective study Place and Duration of Study: Department of Surgery Unit-2, Ghulam Muhammad Mahar Medical College Hospital Sukkur from 1st January 2019 to 31st December 2020. Methodology: One hundred patients who were further divided in two groups with 50 patients each were enrolled after clinical confirmation of appendicitis. Group A was operated through open surgery method while Group B was operated laparoscopically. The data regarding hospital stay, duration of surgery and surgical site infection through both techniques was compared and data analyzed. Results: The mean age of patients was 26.5±5.5 years males with a percentage of 76% where as only 24% of the study cases were females. Patients undergoing laparoscopy were having reduced prevalence of surgical site infection as 10% than who underwent open surgery. Among the 26.54% of reported co-morbidity cases as well, there were 65% those who has surgical site infection with open surgery protocol. Conclusion: Laparoscopic surgery technique is highly efficient in reducing surgical site infection in comparison to open surgery method. Keywords: Appendectomy, Open surgery, Laparoscopic, Surgical site infection

Patterns and Outcomes of Patients with Abdominal Trauma

Aim: To determine the patterns and outcomes of patients with abdominal trauma. Study Design: Prospective cross sectional study Place and duration of study: Department of Surgery, DHQ Hospital Abbottabad from 1st June 2016 to 30th June 2021. Methodology: One hundred and twenty three abdominal trauma male and female patients having age between 18-45 years. Patients with conservative management and failing to provide history of trauma were excluded from the study. We studied the patterns of abdominal trauma and its outcomes in terms of surgical site infection, anemia, mortality and hospital stay. Results: Majority of the patients were male as compared to females (83.7% vs 16.3%). The most effected age group was 21 to 40 years (56.9%). Road traffic accident was the major cause of injury (59.3%). The most common pattern of injury was blunt force trauma (77.2%). Majority of the patients had &lt; 10 days of hospital stay. Surgical site infection was the most common postoperative complication (36.6%). Mortality rate was 11.4%. Conclusion: Blunt force trauma was the most common pattern of injury. Young patients (21-40 years) were more prone to abdominal injuries. Surgical site infection seems to the most common postoperative complication. Key words: Abdonimal trauma, Pattern, Outcome, Blunt force trauma

Effect of pathological complete response after neoadjuvant chemoradiotherapy on postoperative complications of rectal cancer: a systematic review and meta-analysis.

Standard total mesorectal resection has become an important treatment option for locally advanced or high-risk rectal cancer after neoadjuvant chemo-radiotherapy. 15-27% of patients can achieve pathological complete response (PCR) after neoadjuvant chemo-radiotherapy (nCRT). However, the relationship between PCR and postoperative complications remains an important unsolved problem. The objective of this study was to determine whether PCR was associated with the rate of postoperative complications. This meta-analysis was implemented following the recommendations from Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We searched electronic literature by PubMed, EMBASE, and Google Scholar. Major outcomes of interest included anastomotic leakage, surgical-site infection, reoperation, and any postoperative complications. Other outcomes comprised postoperative hemorrhage, ileus, and mortality. Eleven thousand two hundred ninety patients in 9 studies were included in the meta-analysis. The pooled analysis revealed that patients with PCR did not have a higher risk of anastomotic leakage (OR = 1.22, 95% CI 0.92-1.62, p = 0.17), reoperation (OR = 1.13, 95% CI 0.93-1.37, p = 0.22), and any postoperative complications (OR = 1.02, 95% CI 0.91-1.15, p = 0.72) than patients with non-PCR. However, the meta-analysis showed that the PCR group was superior to the non-PCR group in terms of surgical-site infection (9.38% vs. 12.44%OR = 0.68, 95% CI 0.47-0.98; p = 0.04). PCR might not be related to the occurrence of postoperative complications in rectal cancer patients following nCRT. In addition, PCR might be associated with a lower risk of surgical-site infection.

Closure of Abdominal Incisions Following Laparotomy for Peritonitis in Children: Primary Closure or Delayed Primary Closure?

Background: There is need to determine the optimal management strategy for dirty abdominal surgical wounds. The aim of this study was to evaluate the post-operative wound complications in children whose dirty surgical wounds were closed primarily, in relation to those closed by delayed primary closure. Materials and Methods: This was a prospective evaluation of children, aged 15 years and younger, who had laparotomy for peritonitis in a teaching hospital in Enugu, Nigeria. This study covered a 5-year period. The following data were evaluated: patients’ age, gender, presenting symptoms, laboratory results at presentation, duration of symptoms before presentation, time interval between presentation and intervention, intra-operative finding, definitive operative procedure performed, complications of treatment, and outcome of treatment of the 2 groups of patients. Results: A total of 204 cases of peritonitis in children were operated upon during the study period. The incisions were closed by primary closure (Group A) in 104 (51%) while 100 (49%) surgical wounds were closed by delayed primary closure (Group B). More males were involved. All the patients had abdominal pain and about half the patients were anemic and had electrolyte imbalance at presentation. Typhoid intestinal perforation was the most common cause of peritonitis and closure of ileal perforation was the most frequent performed surgical procedure. Comparing the 2 groups of patients, surgical site infection and stitch related were less common in group B patients whose surgical incisions were closed by delayed primary closure. Conclusion: Delayed primary closure of dirty laparotomy incisions has less complication in terms of surgical site infection and stitch related complications. Therefore, delayed primary closure of dirty laparotomy wounds is advocated in pediatric population.

COMPARAÇÃO ENTRE O FECHAMENTO DE OSTOMIA EM BOLSA VS. GRAMPEAMENTO LINEAR EM CRIANÇAS

Type of ostomy closure has connection with some complications and also cosmetic effects. This study aimed to compare result of colostomy closure using purse-string method versus linear method in terms of surgical site infection, surgical time, and patient satisfaction. In this study, 50 patients who underwent purse-string ostomy closure and 50 patients who underwent linear closure were included. Two groups were compared for surgical time, wound infection, patient satisfaction, scar length. A p-value <0.05 was considered significant. Wound infection was not reported among purse-string group compared to 10% in linear group (p=0.022). Scar length was 24.09±0.1 mm in purse string and 52.15±1.0 mm in linear group (p=0.033). Duration of hospital admission was significantly shorter in purse-string group (6.4±1.1 days) compared to linear (15.5±4.6 days, p=0.0001). The Patient and Observer Scar Assessment Scale scale for observer (p=0.038) and parents (p=0.045) was more favorable among purse-string group compared to linear. Purse-string technique has the less frequent surgical site infection, shorter duration of hospital admission, less scar length, and more favorable cosmetic outcome, compared to linear technique.

Intervention Strategies to Reduce Surgical Site Infection Rates in Patients Undergoing Rectal Cancer Surgery

This study aimed to determine the effectiveness of surgical site infection (SSI) prevention approaches in rectal cancer surgery.A total of 1,408 patients who underwent elective rectal cancer surgery between 1995 and 2017 were reviewed. Patients were divided into three groups: control group (group A, n=245), SSI prevention intervention group (group B, n=516), and laparoscopic or robotic surgery group (group C, n=647). The groups were compared in terms of SSI and anastomotic leakage (AL) incidences, and risk factors for SSI were investigated.The overall SSI and AL rates were 19.4% and 3.6%, respectively. These rates were significantly lower in Group C (9.3%, 1.7%), compared to Groups A (40.0%, 6.1%) and B (22.5%, 3.5%). Abdominoperineal resection, open surgery, operation time, intraoperative bleeding, lack of absorbable sutures, lack of mechanical bowel preparation, and lack of oral antibiotics were independently associated with SSI.SSI reduction after rectal cancer surgery was achieved through various intervention strategies.

Chlorhexidine gluconate vs povidone-iodine vaginal antisepsis for urogynecologic surgery: a randomized controlled noninferiority trial

Although povidone-iodine (iodine) is the only Food and Drug Administration-approved vaginal antiseptic solution, there is a lack of comparative data evaluating alternatives. Chlorhexidine gluconate is readily accessible, recommended by multiple societies as an alternative for patients with iodine allergy, and preliminary data indicate that it may provide superior antisepsis. This study aimed to compare the effectiveness of chlorhexidine and iodine as presurgical vaginal antiseptic solutions in preventing the most common surgery-associated infection after gynecologic surgery, urinary tract infections. We conducted a randomized controlled noninferiority trial among women undergoing urogynecologic surgery. The primary outcome measure was symptomatic urinary tract infection within 2 weeks after surgery. The secondary outcomes included culture-proven urinary tract infection at 2 and 6 weeks after surgery, symptomatic urinary tract infections at 6 weeks after surgery, any surgical site infection at 2 weeks after surgery, and patient-reported vaginal irritation after surgery. We required 58 participants per arm to demonstrate noninferiority of chlorhexidine vs iodine (margin of relative risk of <1.5 for the upper limit of 95% confidence interval) between groups for the primary outcome. A total of 119 participants (61 in the chlorhexidine group and 58 in the iodine group) completed the primary outcome and were included in the analyses. There was no difference in the groups' demographic characteristics, medical history, operations performed, or perioperative factors. Chlorhexidine was not inferior to iodine concerning the primary outcome, symptomatic urinary tract infection at 2 weeks after surgery (10% vs 17%; relative risk, 0.6; 95% confidence interval [-∞, 1.3]). Furthermore, chlorhexidine was not inferior to iodine for the secondary urinary tract infection outcomes (culture-proven urinary tract infection at 2 and 6 weeks after surgery and symptomatic urinary tract infection at 6 weeks after surgery). Groups were similar in terms of surgical site infection (overall 3/119 [2.5%]) and presence of any vaginal irritation (4/54 [7.4%], for both groups). Chlorhexidine was not inferior to iodine for vaginal antisepsis before urogynecologic surgery concerning urinary tract infection. Given the similar postoperative urinary tract infection rates demonstrated in this study and the lack of difference in vaginal irritation, chlorhexidine seemed to be a safe and reasonable option for vaginal antisepsis before surgical procedures. Additional studies are needed to further examine surgical site infection.

Comparison of the Effect of Triclosan Coated Polyglactin Sutures and Plain Polyglactin Sutures on Post-operative Healing in Patients Undergoing Surgical Removal of Mandibular Third Molar (MTM)

Background: Surgical site infection (SSI) has been ruled out as having the highest prevalence among infections associated with avoidable health care. The application of coatings and other treatments to medical devices to avoid bacterial colonisation has gotten a lot of press recently. Bacterial growth should be prevented rather than treated because once bacteria have formed a habitat, they form a biofilm that prevents antibiotics from penetrating the infection site. As a result, it would be necessary to incorporate an antimicrobial agent into medical devices.&#x0D; Objectives: The study's main goal is to see how successful, Triclosan Coated polyglactin suture as a wound closure agent in terms of surgical site infection after surgery, bacterial colonization, trismus and pain over the plain conventional one.&#x0D; Methodology: Two groups (Group-I &amp; Group-II) with 15 individuals as subjects are considered for the study model. Systemically healthy individual with presence of mandibular third molar (MTM) with similar difficulty index, depth of, and relationship with ramus will be included in the study sample. Wound closure would be achieved by using antimicrobial triclosan-impregnated 3–0 polyglactin sutures for closing the surgical site using simple interrupted sutures (Group-I) and plain 3–0 polyglactin sutures for closing the surgical using simple interrupted sutures (Group-II), respectively. Post-operatively measurement of surgical site infection, bacterial colonization, trismus and pain will be done.&#x0D; Expected Results: Polyglactin sutures coated with triclosan for closure of wound after MTM surgery, will be successful in minimising post-operative surgical site infection, bacterial colonization, trismus and pain.&#x0D; Conclusion: Use of polyglactin sutures coated with triclosan, aids in the prevention of one of the most prevalent postoperative conditions, surgical site infection(SSI) and to reduces bacterial colonization, trismus and pain. The surgeon's and the patient's need for a positive cosmetic outcome postoperatively is hampered if a postoperative surgical site infection develops, which one can be overcome by their usage.

COMPARISION OF SURGICAL SITE INFECTION BETWEEN OPEN APPENDECTOMY AND LAPAROSCOPIC APPENDECTOMY

Appendectomy is most common surgical procedure in emergency surgery. Inamed appendix can be removed laparoscopically (laparoscopic appendectomy) or openly (open appendectomy). Surgical site infection is representative of health care associated infection in which it may effect on patients' morbidity and mortality. The aim of the study is to compare laparoscopic appendectomy and open appendectomy in terms of surgical site infection. The frequency of 60 patients who underwent appendectomy open appendectomy-40;laparoscopic appendectomy-20 between September 2019- march2020 which were retrospectively reviewed for demographic and pathological characteristic, recovery of bowel movements, length of hospital stay and post-operative complications. The frequency of purulent/gangrenous or perforated appendix were Laparoscopic appendectomy-10% and in open appendectomy 20%. The time of rst atus after surgery were 2.9 days and in open appendectomy were 2.97 days in laparoscopic appendectomy. Length of hospital stay were relatively short in laparoscopic appendectomy group and in open appendectomy group The frequency of overall surgical site infection were not that difference between the two groups laparoscopic appendectomy -15% open appendectomy group were22%But that of supercial surgical site infection was signicantly lower in laparoscopic appendectomy group5% open appendectomy group 15%.

Topical Rifamycin Prophylaxis in Gynecological and Obstetric Surgery

OBJECTIVE: Antibiotic prophylaxis is one of the most important steps to reduce surgical site infections. First-generation cephalosporin (cefazolin) is used prophylactically in the majority of operations. Rifamycin is a broad-spectrum semisynthetic antibiotic that is bactericidal against gram (+) and gram (˗) microorganisms. To the best of our knowledge, there are no studies on the use of rifamycin in antibiotic prophylaxis. In this study, we aimed to analyze whether there is a difference between the use of only cefazolin and only rifamycin in terms of surgical site infections. STUDY DESIGN: One hundred patients were included in this case-control study during the last quarter period of 2017. These patients (n=100) were divided into two groups according to their antibiotic use; 50 patients who received only 1 g cefazolin constituted Group 1, 50 patients who received only 250 mg topical rifamycin over the incision line based on surgeon’s preference constituted Group 2. RESULTS: The use of prophylactic topical rifamycin reduced the incidence of wound infection. compared with cefazolin. Surgical site infection was detected in 5 (10%) of the patients who received cefazolin, whereas surgical site infection was not observed in patients who received rifamycin (p=0.022). CONCLUSIONS: The use of topical rifamycin is effective but does not imply that systemic antibiotics should replace prophylaxis. The use of rifamycin would aid in systemic antibiotic prophylaxis.