Infective complications in laparoscopic surgery.
OBJECTIVE
One of the main benefits of minimally invasive surgery compared with open surgery is the significant reduction in the incidence of postoperative infections. Possible explanations include the smaller incision, minimal use of central venous catheters for parenteral nutrition, faster mobilization, reduction in postoperative pain, and better preservation of immune system function with a limited inflammatory response to tissue injury. We compare the incidence of postoperative infections after the most common laparoscopic surgical procedures with that after the corresponding open operation, and review the possible mechanisms behind these results.


METHODS
Review of the pertinent literature.


RESULTS
Several randomized controlled trials (RCTs), as well as most retrospective studies, show a significant reduction in incisional complications with laparoscopic cholecystectomy in comparison with open surgery (mean 1.1% vs. 4%), as well as in urinary tract and pulmonary infections. In colorectal resection, laparoscopic surgery was characterized by a significant reduction in surgical site infections (mean 5% vs. 9.5%), and the infections that did occur tended to be less severe. Again, there were fewer urinary and pulmonary infections postoperatively. Acute appendicitis represents an interesting setting to study the effect of minimally invasive surgery on infections, as it involves a potentially contaminated field. Most of the results confirm that the rates of surgical site (mean 2% versus 8%) and respiratory (mean 0.3% versus 3%) infections favor laparoscopic surgery, but minimally invasive surgery seems to be characterized by a higher incidence of postoperative intra-abdominal abscess. The laparoscopic approach to splenectomy is clearly superior to standard laparotomy in terms of postoperative complications, including infections, although the rate of overwhelming postsplenectomy infection (OPSI) remains similar because this complication is related more to spleen removal than to the surgical approach.


CONCLUSIONS
Most of the literature is in agreement that laparoscopic surgery is associated with better preservation of immune function and a reduction of the inflammatory response compared with open surgery. The rate of postoperative infections seems to be significantly lower.
Boni
Luigi
L
Department of Surgical Sciences, University of Insubria, Varese, Italy. bonil@tin.it
Benevento
Angelo
A
Rovera
Francesca
F
Dionigi
Gianlorenzo
G
Di Giuseppe
Matteo
M
Bertoglio
Camillo
C
Dionigi
Renzo
R
D006801:Humans; D007239:Infections / Q000453:epidemiology* / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology*; D013530:Surgical Wound Infection / Q000453:epidemiology