Fifty-seven patients underwent laparoscopic-assisted colectomy with the use of a wound protector during specimen extraction and anastomosis. Demographic data are described in Table 3. Of the 7 patients (12.28%) with medical complications, the most common complication was adhesive intestinal obstruction (n = 3, 5.26%), followed by uroschesis (n = 2, 3.51%), and the complications with the lowest incidences were anastomotic leakage (n = 1, 1.75%) and wound infection (n = 1, 1.75%). However, in the nonwound protector group, the most common complication was wound infection (n = 7, 13.46%), followed by adhesive intestinal obstruction (n = 3, 5.77%), and uroschesis (n = 2, 3.85%), and the complications with the lowest incidence was adhesive intestinal obstruction (n = 1, 1.92%). Therefore, the wound infection rates were significantly lower in the wound protector group compared to the nonwound protector group (1.75% vs 13.46%, P = .02), while there were no differences in other complications (uroschesis, adhesive intestinal obstruction, and anastomotic leakage).
Patients with SSIs have to extended length of hospitalization time and increased costs of treatment. In addition, SSIs is a risk factor for incisional hernia, which may require an additional operation.[22,23] Furthermore, SSIs could lead to systemic infection and even death. These adverse factors caused the patients’ physical and mental injury. What is more, the treatment of these infections consumes additional hospital resources ranging from the administration of antibiotics and dressing to telephone or outpatient follow-up for wound reevaluation.[24,25]
The preventive effects of plastic wound protectors on wound contamination and subsequent infection have been investigated since 1960s, although there have been conflicting reports. Initially, Harrower reported that patients undergoing intestinal and biliary surgery using a wound liner had a lower incidence of postoperative wound infection (2.4% vs 15%). Then, Nystrom and Brote also reported that a plastic wound drape could reduce wound infections in appendicitis operations. Recently, studies have demonstrated that wound protectors had practical significance in reducing SSIs during gastrointestinal and biliary surgeries.[28–30] Nevertheless, Kercher et al reported no protective effect with the use of a wound protector in a retrospective analysis of clinical data from 141 performed laparoscopic CRC operations. A similar conclusion has been reached by Kercher following a group of 109 patients. Williams et al drew a unanimous conclusion. In this study based upon comparing the clinical data from CRC patients in the wound protector and the no wound protector groups, the results showed that the wound protectors can significantly reduce wound infection rates, thus promoting increased hospital turnover and reduced hospital stays.
The previous study showed silicone film is the main components of the plastic wound protectors, which could effectively prevent the abdominal tumor cells planting wound incisions. However, there are no definitive data to indicate that rate of tumor seeding is decreased by using plastic wound protectors in surgical procedure.[32,33] Furthermore, current data suggest that the wound recurrence is rare, and there are no significant differences between laparoscopic colectomy and previous open colectomy. In this study, we have not observed wound recurrences in the 109 patients after undergoing laparoscopic-assisted colectomy with or without plastic wound protectors, due to lack of samples and short follow-up. In the next, we will continue to use plastic wound protectors in CRC patients who undergo laparoscopic colectomy to explore the risk factors of wound recurrence.
The present study has several limitations. The single-institution, retrospective nature of our investigation is prone to selection bias. We minimized this bias by including all colectomies that met the selection criteria during the defined study period. Another noteworthy limitation is whether the plastic wound protector was used in surgery. Finally, there were not enough patients with CRC to include in the study. Despite these limitations, this study presents significant findings that underscore the need for future randomized prospective trials.
The authors thank the grant from Municipal Commission of Health and Family Planning of Shanghai, China (no. 201540031 to MZ) for the support.
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