title: An intraoperative technique to reduce superficial surgical site infections in circular stapler-constructed laparoscopic Roux-en-Y gastric bypass.
abstract: BACKGROUND
  Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been established as one of the most effective treatments for morbid obesity. Surgical site infections are the most common complication after LRYGB surgery.
  
  
  OBJECTIVE
  To compare the superficial surgical site infections (sSSI) rate before and after the implementation of our intraoperative technique.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  Our intraoperative technique relies on sterile coverage of the circular stapler, sterile specimen-bag retrieval of the gastrojejunostomy enteric remnant, and port site Penrose drainage. We analyzed our sSSI outcomes before and after implementation of our technique in all LRYGBs performed by a single surgeon from 2009 to 2015. We took into account patient age; sex; baseline body mass index (BMI); smoking status; and co-morbidities such as diabetes, hypertension, and hyperlipidemia. χ(2) and multivariate analysis were performed.
  
  
  RESULTS
  We performed 486 LRYGBs in 2009-2015. The cohort before implementation of our technique (group 1) included 164 patients (33.7%) and the cohort after implementation (group 2) included 322 patients (66.3%). Both groups were similar in age, sex, smoking status, and rates of diabetes and hyperlipidemia but differed in BMI, operative time, and prevalence of hypertension. Hypertension was not a confounder for sSSI (P = .35). The sSSI rate was 9.15% for group 1 and 3.42% for group 2 (P = .0079). Controlling for BMI and operative time, multivariate analysis revealed a significant reduction in sSSI (odds ratio 2.98 [95% CI 1.33-6.69]) with our technique.
  
  
  CONCLUSIONS
  We describe a reproducible intraoperative technique that significantly reduces sSSI in LRYGB procedures. Our technique has the potential of hastening postoperative recovery.
authors.affiliation: Montefiore Institute for Minimally Invasive Surgery, Montefiore Medical Center, Bronx, New York; Albert Einstein College of Medicine, Department of Surgery, Bronx, New York.
authors.forename: Yang
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Montefiore Institute for Minimally Invasive Surgery, Montefiore Medical Center, Bronx, New York; Albert Einstein College of Medicine, Department of Surgery, Bronx, New York.
authors.forename: Oscar K
authors.initials: OK
authors.lastname: Serrano
authors.affiliation: Montefiore Institute for Minimally Invasive Surgery, Montefiore Medical Center, Bronx, New York; Albert Einstein College of Medicine, Department of Surgery, Bronx, New York.
authors.forename: W
authors.initials: W
authors.lastname: Scott Melvin
authors.affiliation: Montefiore Institute for Minimally Invasive Surgery, Montefiore Medical Center, Bronx, New York; Albert Einstein College of Medicine, Department of Surgery, Bronx, New York. Electronic address: DICAMACH@montefiore.org.
authors.forename: Diego
authors.initials: D
authors.lastname: Camacho
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D019072:Antibiotic Prophylaxis / Q000379:methods; D004866:Equipment Contamination / Q000517:prevention & control; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery; D061646:Operative Time; D010359:Patient Readmission / Q000706:statistics & numerical data; D017792:Surgical Stapling / Q000379:methods*; D013530:Surgical Wound Infection / Q000517:prevention & control*; D016896:Treatment Outcome
keywords: Bariatric Surgery; Intraoperative Technique; Laparoscopic Roux-en-Y Gastric Bypass; Morbid Obesity; Surgical Site Infection; Wound Infection