title: Laparoscopic surgery compared with open surgery decreases surgical site infection in obese patients: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To compare surgical site infections rate in obese patients after laparoscopic surgery with open general abdominal surgery.
  
  
  BACKGROUND
  In mixed surgical populations, surgical site infections are fewer in laparoscopic surgery than in open surgery. It is not clear if this is also the case for obese patients, who have a higher risk of surgical site infections than nonobese patients.
  
  
  METHODS
  MEDLINE, Embase, and The Cochrane library (CENTRAL) were searched systematically for studies on laparoscopic surgery compared with open abdominal surgery. Randomized controlled trials (RCTs) and observational studies reporting surgical site infection in groups of obese patients (body mass index ≥ 30) were included. Separate meta-analyses with a fixed effects model for RCTs and a random effects model for observational studies were performed. Methodological quality of the included studies was assessed according to the Cochrane method and the Newcastle-Ottawa Scale.
  
  
  RESULTS
  Eight RCTs and 36 observational studies on bariatric and nonbariatric surgery were identified. Meta-analyses of RCTs and observational studies showed a significantly lower surgical site infection rate after laparoscopic surgery (OR = 0.19; 95% CI [0.08-0.45]; P = 0.0002 and OR = 0.33; 95% CI [0.26-0.42]; P = 0.00001). Sensitivity analyses to assess the impact of selection and detection bias confirmed the significant estimates with acceptable heterogeneity. No publication bias was present for the observational studies.
  
  
  CONCLUSIONS
  Laparoscopic surgery in obese patients reduces surgical site infection rate by 70%-80% compared with open surgery across general abdominal surgical procedures. Future efforts should be focused on further development of laparoscopic surgery for the growing obese population.
authors.affiliation: Department of Surgery K, Bispebjerg Hospital, Copenhagen, Denmark. dmshaban@gmail.com
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Shabanzadeh
authors.forename: Lars T
authors.initials: LT
authors.lastname: Sørensen
mesh_terms: D000005:Abdomen / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D009765:Obesity / Q000150:complications*; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology* / Q000517:prevention & control*