title: Back to basics--cutting the cord on umbilical infections.
abstract: BACKGROUND
  Surgical site infections (SSIs) are a significant cause of postoperative morbidity with laparoscopic surgery associated with lower SSI rates. However, a departmental change in our unit to increased laparoscopic colorectal surgery resulted in increased wound infection rates  at umbilical specimen extraction sites, the cause of which we attempted to elucidate.
  
  
  METHODS
  Prospectively collected data over an 18-month period (April 2008 to September 2009) for laparoscopic colorectal operations in a busy teaching hospital were retrospectively analysed,  focusing on operation performed, whether pre-operative skin cleansing was employed, nature of specimen extraction excision, and rate of umbilical wound infection. Comparison was made with open colorectal procedures performed in the preceding year.
  
  
  RESULTS
  In total, 275 laparoscopic colorectal  operations were performed. Over the first 8 months there was a significant increase in infection rates when compared with open procedures over a similar time period (23.5% vs 8.0%; P = 0.0001). Changing practice to use pre-operative skin cleansing and an incision that skirted around,  as opposed to traversing, the umbilicus reduced umbilical infection rates significantly from 23.5% to 11.6% (P = 0.01). Patients undergoing right hemicolectomy benefitted more (reduction of 30.0% to 6.9%; P = 0.04) than those undergoing anterior resection (26.8% vs 15.6%, P  = 0.13).
  
  
  CONCLUSIONS
  Umbilical incisions, when extended for specimen extraction, are particularly prone to infection following colorectal surgery but rates can be reduced by simple measures such as pre-operative umbilical cleansing and avoidance of the umbilicus in the incision, without  the need for drastic and costly changes in technique or antibiotic prophylaxis.
authors.affiliation: University Hospital of North Staffordshire, Stoke on Trent, UK. alsharples@yahoo.co.uk
authors.forename: Alistair
authors.initials: A
authors.lastname: Sharples
authors.forename: David
authors.initials: D
authors.lastname: McArthur
authors.forename: Kate
authors.initials: K
authors.lastname: McNamara
authors.forename: John
authors.initials: J
authors.lastname: Lengyel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003106:Colon / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D014472:Umbilicus; D055815:Young Adult