Clinician Article

Laparoscopic surgery compared with open surgery decreases surgical site infection in obese patients: a systematic review and meta-analysis.

  • Shabanzadeh DM
  • Sorensen LT
Ann Surg. 2012 Dec;256(6):934-45. doi: 10.1097/SLA.0b013e318269a46b. (Review)
PMID: 23108128
Read abstract Read evidence summary
  • Special Interest - Obesity -- Surgeon
    Relevance - 7/7
    Newsworthiness - 6/7
  • Surgery - Gastrointestinal
    Relevance - 6/7
    Newsworthiness - 5/7
  • Infectious Disease
    Relevance - 6/7
    Newsworthiness - 4/7
  • Surgery - General
    Relevance - 6/7
    Newsworthiness - 4/7


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.

Clinical Comments

Infectious Disease

Numerous RCTs and an earlier meta-analyses have shown convincingly that the laparoscopic approach, as contrasted with open laparotomy, is associated with a lower risk of postoperative SSI and shorter hospitalization, and the laparoscopic approach has become the standard for most types of GI surgery and, increasingly, gynecologic surgery, and herniorrhaphy. This well-done meta-analysis shows that in morbidly obese patients, who have much higher risks of SSI and other postoperative complications, the laparoscopic approach is associated with a significantly lower risk of SSI. Unfortunately the analysis provides no information on other surgical complications or LOS. Moreover, a recent very large study (Obes Surg 2006;16:721-7) challenges the thesis that a laparoscopic approach provides superior results in the most common bariatric operation, Roux-en-Y gastric bypass.

Infectious Disease

Widely believed but nice to see it confirmed by data.

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