title: ALEXIS O-Ring wound retractor vs conventional wound protection for the prevention of surgical site infections in colorectal resections(1).
abstract: OBJECTIVE
  Surgical site infection (SSI) remains a common postoperative morbidity, particularly in colorectal resections, and poses a significant financial burden to the healthcare system. The omission of mechanical bowel preparation, as is performed in enhanced recovery after surgery programmes, appears to further increase the incidence. Various wound protection methods have been devised to reduce the incidence of SSIs. However, there are few randomized controlled trials assessing their efficacy. The aim of this study is to investigate whether ALEXIS wound retractors with reinforced O-rings are superior to conventional wound protection methods in preventing SSIs in colorectal resections.
  
  
  METHODS
  Patients undergoing elective open colorectal resections via a standardized midline laparotomy were prospectively randomized to either ALEXIS or conventional wound protection in a double-blinded manner. A sample size of 30 in each arm was determined to detect a reduction of SSI from 20% to 1% with a power of 80%. Secondary outcomes included postoperative pain. The operative wound was inspected daily by a specialist wound nurse during admission, and again 30 days postoperatively. Statistical analysis was performed using spss version 13 with P < 0.05 considered significant.
  
  
  RESULTS
  Seventy-two patients were recruited into the study but eight were excluded. There were no SSIs in the ALEXIS study arm (n = 34) but six superficial incisional SSIs (20%) were diagnosed in the control arm (P = 0.006). Postoperative pain score analysis did not demonstrate any difference between the two groups (P = 0.664).
  
  
  CONCLUSIONS
  The ALEXIS wound retractor is more effective in preventing SSI in elective colorectal resections compared with conventional methods.
authors.affiliation: Department of Surgery, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: K P
authors.initials: KP
authors.lastname: Cheng
authors.forename: A C
authors.initials: AC
authors.lastname: Roslani
authors.forename: N
authors.initials: N
authors.lastname: Sehha
authors.forename: J H
authors.initials: JH
authors.lastname: Kueh
authors.forename: C W
authors.initials: CW
authors.lastname: Law
authors.forename: H Y
authors.initials: HY
authors.lastname: Chong
authors.forename: K
authors.initials: K
authors.lastname: Arumugam
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003107:Colorectal Surgery / Q000009:adverse effects* / Q000295:instrumentation*; D004311:Double-Blind Method; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D018709:Statistics, Nonparametric; D013530:Surgical Wound Infection / Q000209:etiology* / Q000517:prevention & control*; D055815:Young Adult