Introduction Laparoscopic surgery has definite potential advantages compared to open surgery in colorectal procedures like smaller wounds, less post operative pain, earlier recovery and discharge. Surgical site infections (SSI) are a considerable burden for the healthcare community. They are the commonest health care acquired infections and increase the morbidity and mortality of surgical procedures significantly. This meta analysis was carried out to assess if laparoscopic surgery reduces the incidence of surgical site infections compared to open surgery for colorectal procedures.
Method A thorough electronic search was conducted and relevant journals and articles were also hand searched. Randomised controlled trials published since 2000 and comparing outcomes after laparoscopic and open colorectal surgery were included in the review. Operative procedures for a range of colorectal pathologies including colorectal cancer, inflammatory bowel disease and FAP were included in the analysis. Revman 5.2 was used for statistical analysis. Data were pooled and the results were shown as risk ratio with 95% confidence intervals using the fixed methods model.
Results 16 randomised controlled trials were included in the analysis and represented 5797 patients. Analysis showed a statistically significant lower wound infection rate (Risk ratio: 0.72, 95% Confidence intervals: 0.60, 0.88, P = 0.001) and statistically insignificant lower abdominal abscess formation rate (Risk ratio: 0.88, 95% confidence intervals: 0.62, 1.27, P = 0.51). On combining both the wound infections and abdominal abscesses, a statistically significant lower surgical site infection rate (Risk ratio: 0.76, 95% confidence intervals: 0.64, 0.90, P = 0.001) was deduced.
Conclusion SSI is a major burden on the healthcare system. They are the commonest forms of healthcare acquired infections and put a significant strain on hospital and community resources. The estimated cost to the NHS on reoperations, wound dressings, nursing care and medications is approximately 1 billion every year. There are additional costs of social care, community support and loss of work. This meta analysis has shown that laparoscopic surgery reduces the incidence of SSI in colorectal procedures compared to open surgery. Obviously the benefits in terms of health as well as economic benefits will be immense.
Disclosure of interest None Declared.