OUP accepted manuscript

The efficacy of wound edge protectors in reducing the post-operative surgical site infections after abdominal surgery: a meta-analysis of randomized clinical studies

Introduction

Following abdominal surgery, surgical site infections (SSIs) are a common complication. The effectiveness of wound edge protectors in preventing SSI remains uncertain.

Aim

To determine the clinical effectiveness of a wound edge protector (WEP) in preventing surgical site infections (SSIs) after abdominal surgery.

Material and methods

A systematic search of the Cochrane Library, PubMed, Embase, and Web of Science yielded all relevant articles published through October 2022. The major evidence regarding the efficacy of WEPs in minimizing SSIs in abdominal surgery patients relative to the standard of care was determined by searching the literature. The primary outcome was SSI as clinically defined by CDC. To combine qualitative factors, risk ratios (RRs) were used.

Results

WEPs were related to a decreased incidence of SSI overall (RR = 0.75; 95% CI: 0.61-0.91; p = 0.004). WEPs are efficient in lowering the incidence of SSI at various abdominal surgical sites, with RR = 0.67; 95% CI: 0.47-0.96; p = 0.03 for pancreatoduodenectomy, RR = 0.52; 95% CI: 0.31-0.86; p = 0.01 for colorectal surgery, and RR = 0.39; 95% CI: 0.21-0.73; p = 0.003 for abdominal surgery. Moreover, both kinds of WEPs (single-ring and double-ring devices) were successful in lowering the risk of SSIs, with RR = 0.66; 95% CI: 0.47-0.93; p = 0.02 for double-ring devices and RR = 0.76; 95% CI: 0.58-0.98; p = 0.04 for single-ring devices.

Conclusions

These findings demonstrate that double- and single-ring wound edge protection devices are effective in preventing surgical site infections following pancreatoduodenectomy, colorectal, and abdominal procedures.

Preparing the Bowel (Microbiome) for Surgery: Surgical Bioresilience

The preparation of the bowel for radical surgery is a corner stone of elective colorectal practice. The evidence for this intervention is of variable quality and it is often contradictory, yet there is now a global move toward the adoption of oral antibiotic therapy for the reduction of perioperative infective complications, such as surgical site infections. The gut microbiome is a critical mediator of the systemic inflammatory response to surgical injury, wound healing, and perioperative gut function. The loss of critical microbial symbiotic functions caused by bowel preparation and surgery has an adverse impact on surgical outcomes, yet the mechanisms through which this occurs are poorly defined. In this review, the evidence for bowel preparation strategies is critically appraised in the context of the gut microbiome. The impact of antibiotic therapy on the surgical gut microbiome and the importance of the intestinal "resistome" to surgical recovery is described. Data to support the augmentation of the microbiome through diet, probiotic and symbiotic approaches, as well as fecal transplantation are also appraised. Finally, we propose a novel strategy of bowel preparation defined as " surgical bioresilience " and define areas or prioritization in this emerging field. This describes the optimization of surgical intestinal homeostasis and core surgical exposome-microbiome interactions that regulate the wound immune microenvironment, the systemic inflammatory response to surgical injury, and gut function across the perioperative time course.

Effect of wound protectors in reducing the incidence of surgical site wound infection in lower gastrointestinal surgery: A meta-analysis

We performed a meta-analysis to evaluate the effect of wound protectors in reducing the incidence of surgical site wound infection in lower gastrointestinal surgery. A systematic literature search up to June 2022 was performed and 6026 subjects with lower gastrointestinal surgery at the baseline of the studies; 3090 of them were using the wound protector, and 2936 were using no wound protector. Odds ratio (OR) with 95% confidence intervals (CIs) were calculated to assess the effect of wound protectors in reducing the incidence of surgical site wound infection in lower gastrointestinal surgery using the dichotomous methods with a random or fixed-effect model. The surgical site wound infection was significantly lower with single-ring wound protectors (OR, 0.53; 95% CI, 0.39-0.83, P = .004), and dual-ring wound protectors (OR, 0.44; 95% CI, 0.35-0.56, P < .001) in subjects with lower gastrointestinal surgery compared with no wound protector. The surgical site wound infection was significantly lower with single-ring wound protectors, and dual-ring wound protectors in subjects with lower gastrointestinal surgery compared with no wound protector. The analysis of outcomes should be with caution because of the low sample size of 5 out of 28 studies in the meta-analysis and a low number of studies in certain comparisons.