title: Transumbilical abdominal incision for laparoscopic colorectal surgery does not increase the risk of postoperative surgical site infection.
abstract: OBJECTIVE
  Besides antibiotic prophylaxis, antiseptic skin preparation is an important measure to prevent surgical site infection (SSI). No reports have detailed the relationship between SSI and umbilical microflora following laparoscopic colorectal cancer with a transumbilical longitudinal incision.
  
  
  METHODS
  Risk factors and the rate of SSI were investigated in 453 patients who underwent laparoscopic colorectal resection over a 3-year period. Microbiological samples were collected from the umbilicus and SSI areas.
  
  
  RESULTS
  After laparoscopic procedure, we observed SSIs in approximately 5% of cases, with superficial SSI in 15 (3.3%) patients and organ/space SSIs 7 (1.5%). In univariate analysis, preoperative albumin (Alb) value and anastomosis of enterocolostomy were significantly associated with superficial SSI development. Also, age, blood loss, stoma, tumor site (rectum), and Hartmann/abdominal perineal resection (APR) were significant risk factors for organ/space SSI. In multivariate analysis, the preoperative Alb value was the most significant factor associated with a predisposition to superficial SSI. The bacteria detected in SSI were mostly different from those at wound closure. Antibiotic-resistant bacteria were included in organ/space SSI all cases.
  
  
  CONCLUSIONS
  SSI development with laparoscopic surgery reportedly occurs in about 3-15% cases. The SSI rate in this study and other reports was comparable. Using small transumbilical longitudinal incision in laparoscopic colorectal surgery is less likely to cause SSI when sufficient control measures are enacted, even though the umbilicus contains resident bacteria in abundance.
authors.affiliation: Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan. ymizunori@gmail.com.
authors.forename: Mizunori
authors.initials: M
authors.lastname: Yaegashi
authors.affiliation: Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
authors.forename: Koki
authors.initials: K
authors.lastname: Otsuka
authors.affiliation: Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
authors.forename: Toshimoto
authors.initials: T
authors.lastname: Kimura
authors.affiliation: Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Hakozaki
authors.affiliation: Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
authors.forename: Megumu
authors.initials: M
authors.lastname: Kamishima
authors.affiliation: Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Hatanaka
authors.affiliation: Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Sato
authors.affiliation: Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Fujii
authors.affiliation: Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
authors.forename: Teppei
authors.initials: T
authors.lastname: Matsuo
authors.affiliation: Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Sasaki
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000302:isolation & purification; D003107:Colorectal Surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012867:Skin / Q000382:microbiology; D013530:Surgical Wound Infection / Q000209:etiology* / Q000382:microbiology; D014472:Umbilicus / Q000601:surgery*
keywords: Colorectal surgery; Laparoscopic surgery; Surgical site infection; Transumbilical abdominal incision; Umbilical flora