The evolution of laparoscopy in abdominal surgery: a meta-analysis of the effect on infectious outcomes.
BACKGROUND
Laparoscopic surgery has been recommended as an effective strategy because of its advantages in decreasing abdominal surgical site infections (SSIs). The aim of this study was to assess the effect of laparoscopy on superficial and organ/space SSIs compared with open surgery in hollow-viscus procedures over time.


METHODS
Data on SSIs from randomized-controlled trials (RCTs) evaluating open versus laparoscopic abdominal surgeries were extracted from the Cochrane Database Reviews. Re-analysis of these data was performed to assess infections. Heterogeneity was also explored. A subgroup analysis was performed according to elective/emergency surgery status.


RESULTS
Data from 72 RCTs including 8218 patients were collected (4116 patients in the laparoscopic group and 4102 patients in the open group). For superficial SSI, the pooled RD was -4.4% (95% CI: -5.4% to -3.3%), which indicated a lower risk in the laparoscopic group. For organ/space SSI, the pooled RD was 0.5% (95% CI: -0.1% to 1%), which indicated similar rates between the groups. Changes in SSI frequency had occurred over time.


CONCLUSIONS
Laparoscopic surgery significantly decreases the risk of superficial SSI but does not affect the risk of organ/space SSI. Experience with technique improves outcomes.
Department of Surgery, School of Medicine, Universidad de La Sabana , Chia , Colombia.
Alvaro
A
Sanabria
Valentin
V
Vega
Luis C
LC
Dominguez
Erick
E
Espitia
Adriana
A
Serna
Camilo
C
Osorio
D000005:Abdomen; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology*