Comparative Analyses on Laparoscopic Surgery Versus Open Surgery in Reducing Surgical Site Infection

Abstract

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. Objective: To compare surgical site infections rate in obese patients after laparoscopic surgery with open general abdominal surgery. Methods: A Prospective study was conducted in government Cuddalore Medical Collage and Hospital, Chidambaram, involving patients who underwent laparoscopic surgery and open surgery. Data were collected on demographics variables, clinical features, treatment duration, time to clinical improvement hospital stay length, adverse events, and overall treatment outcomes. Comparative statistical analysis were performed to assess differences between the two groups. Result: Laparoscopic Surgery is Associated with Lower risk of Surgical Site Infections (SSIs): Compared to open surgery, laparoscopic surgery is linked to a reduced risk of SSIs. Significant reduction in SSI rates: The analysis revealed a statistically significant decrease in SSI rates in patients undergoing laparoscopic surgery. Greatest benefit in Colorectal Surgery: Subgroup analysis showed that the benefit of laparoscopic surgery was most pronounced in patients undergoing colorectal surgery. Implications: Surgical practice: The findings suggest that laparoscopic surgery should be considered as a preferred approach to reduce SSI rates. Patient outcomes: The reduced risk of SSIs associated with laparoscopic surgery may lead to improved patient outcomes, including reduced morbidity and mortality. Conclusion: In this retrospective cohort study comparing the outcomes of laparoscopic and OS, it was clearly demonstrated that laparoscopic procedures offered statistically significant advantages over traditional open surgeries in terms of shorter operative times, less blood loss, and shorter hospital stays following surgery.

Keywords

Introduction

Table 1. Demographics and baseline characteristics of the study patients.

In the laparoscopic group, 82 patients (76.19%) were classified as Class I, while 23 were classified as Class II. In contrast, in the OS group, 49 patients in Class I (65.33%) and 26 patients in Class II (34.67%) were classified (p < 0.05). The corresponding p-values were 0.0321 and 0.0154, both of which were statistically significant, indicating a genuine distinction between the two surgical techniques in terms of wound classification (Figure 1). The average operative time for the laparoscopic group was 57.19 minutes. In contrast, in OS group had a significantly prolonged average operative time of 85.10 ±15.18 minutes (p < 0.05). Eighteen patients (17.14%) required a drainage system in the laparoscopic and 26 (34.66%) in the OS group (p< 0.05). In the Laparoscopic group, mean blood loss was 120.76 ±13.3 mL and 170.01 ± 17.19 mL in the OS group (p < 0.05). These all parameters significantly highlighted the prospective advantages of laparoscopic surgery over OS (Table2).

Figure 1

Table 2. Comparative clinical and operative outcomes between laparoscopic and OS groups.

Comparing the postoperative outcomes of laparoscopic (n = 105) and OS (n = 75) cohorts, the laparoscopic cohort had substantially (p < 0.05) shorter average hospital stay (2.1 ± 1.1 days vs. 4.4 ± 2.1 days). In addition, a greater proportion of laparoscopic patients were discharged within 24 h (20.95 vs. 10.66%) (p < 0.05). The use of prophylactic antibiotics was nearly statistically significant in the OS cohort (92% vs. 83.90%) (p < 0.05). Significantly more postoperative complications (p < 0.05) occurred in the group undergoing OS (50.66 vs. 25.71%). This study indicated that laparoscopic surgery has advantages in terms of shorter hospital stays and fewer complications, whereas the use of prophylactic antibiotics is more prevalent in OS (Table 3).

Table 3. Comparative clinical outcomes and treatment measures.

On the 14th day after surgery, the Wound Asepsis Score showed a modest difference, with the laparoscopic group bearing mean score of 8.8 ± 3.1 and the OS group with a mean score of 9.0 ± 5.9 (p > 0.05). SSIs were observed in 5 patients (4.76%) in the laparoscopic group and 7 patients (9.33%) in the OS group within 30 days after surgery (p < 0.05). Patients in the laparoscopic group resumed their normal activities on average 6.40 ± 2.09 days after surgery (p < 0.05). On the 14th day following surgery, VAS pain scores revealed that the laparoscopic group a had mean score of 1.8 ± 0.23, while the OS group reported a 2.7 ± 1.27, bearing a significant difference in pain perception (p < 0.05). These findings suggested that laparoscopic surgery was associated with faster recovery, reduced pain scores, and Wound Asepsis Scores than OS (Table 4).

Table 4. Comparative analysis of postoperative outcomes between laparoscopic and OS procedures.

Comparing the surgical indications of the laparoscopic (n = 105) and OS (n = 75) groups, appendicitis was the rationale for surgery for 39 patients in the laparoscopic group (37.14%) and 33 patients in the OS group (44.0%) (p > 0.05). Gallstones were the most prevalent reason for surgery in the laparoscopic group, with 45 patients (42.8%) versus 21 patients (28.0%) in the OS group (p < 0.05). 13 (12.38%) and 15 patients (20%) underwent surgery for hernias, respectively (p > 0.05). Other indications for surgery were present in 8 patients (7.61%) in the laparoscopic group and 6 patients (8.0%) in the OS group (p > 0.05). While gallstones were substantially more common indications for laparoscopic surgery (p < 0.05), appendicitis, hernia, and other conditions showed non-statistically significant differences between the two surgical approaches (Figure 2).

Figure 2

Figure 3

Figure 4

Table 5. Comparative analysis of complications and management.

Table 6. Postoperative pain scores on Day 1, 3, and 7.

4. DISCUSSION:

This study compared the wound infection rates and postoperative recovery outcomes between two surgical modalities. Our research highlighted several vital findings. First, despite comparable demographic profiles, there were statistically significant differences in gender distribution between the two groups. Importantly, our research revealed the prospective benefits of laparoscopic surgery in a few parameters. The classification of wounds revealed a substantial difference in the severity of wounds between the two techniques, with OS resulting in a greater proportion of Class-II wounds. In addition, operative periods for laparoscopic procedures were significantly reduced, confirming that laparoscopic procedures may be less time-consuming and potentially less invasive. The decreased operative time in the laparoscopic group can be attributed to the technological advancements of laparoscopy, which allow for a more streamlined procedure, less tissue manipulation, and smaller incisions. In addition, postoperative outcomes favoured laparoscopic surgery, with patients requiring shorter hospital stays and experiencing fewer complications. These results were consistent with the existing literature, which demonstrated that the reduced invasiveness of laparoscopic procedures results in less postoperative discomfort and a quicker recovery. Comparison to open hepatectomy (OH), laparoscopic hepatectomy (LH) has lower rates of overall and significant complications, postoperative mortality, and improved 1- year, 2-year, and 5-year overall survival rates. LH was also associated with secondary outcomes such as diminished blood loss, shorter hospital stays, and fewer complications such as liver failure and ascites. However, operation duration and transfusion rates did not differ substantially between groups but in minor liver resections, LH demonstrated favourable outcomes. Similar research examined 14 retrospective cohorts containing 1767 patients. The two surgical approaches showed no significant variance in immediate postoperative complications. In contrast, laparoscopic excision patients demonstrated significant improvements in long-term and total postoperative complications, intraoperative blood loss, transfusion requirements, time to initial feeding, and hospital stay duration. Laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy demonstrated equivalent or superior intraoperative and postoperative outcomes than open excision for children with Choledochal cysts. While the Wound Asepsis Scores on the fourteenth day after surgery were comparable between the two groups, the reduced rates of SSIs and the quicker return to daily activities among laparoscopic patients highlighted the prospective advantages of this modality. This may be a result of the smaller incision diameters and reduced tissue manipulation associated with laparoscopic techniques, resulting in faster wound healing and decreased infection risk. Gallstones emerged as the most frequent indication for laparoscopic surgery. While some parameters, such as wound infection rates, were comparable between the two groups in terms of postoperative complications, there were significant differences in others. The higher incidence of postoperative bleeding and abscess formation in the OS group may be indicative of the technique's increased invasiveness. Nevertheless, certain complications like seroma formation, incisional hernia, and deep vein thrombosis remained consistent between both groups, highlighting that some risks were inherent to the surgical procedure itself, regardless of the technique employed. In a similar study published in Nature, laparoscopic cholecystectomy was compared to conventional laparoscopic cholecystectomy (CLC). It was concluded that single-incision laparoscopic cholecystectomy emerged as a viable and complication-free alternative to CLC for benign gallbladder surgery, particularly in younger female patients who have not undergone abdominal surgery previously. The consistent reporting of reduced pain scores among laparoscopic patients throughout the evaluated postoperative days was a factor requiring attention. This may be due to the minimally invasive nature of laparoscopy, which resulted in less tissue trauma, smaller incisions, and consequently less discomfort. Laparoscopic appendectomy (LA) performed better than open appendectomy (OA) in terms of reduced pain on the first day, fewer wound infections, shorter hospital stays, and a speedier return to regular activities, despite a slightly higher incidence of intra-abdominal abscesses. Laparoscopic surgery has well- known short-term benefits for surgical patients. In oncological procedures, laparoscopy ensures important technical objectives, such as adequate margin clearances and lymph node retrieval, both of which are essential to cancer outcomes. Although recurrence and survival rates are essentially unaffected by laparoscopy, laparoscopic liver resections may indicate an improvement in overall survival rates. In addition, while this study provided significant insights into the relative advantages of laparoscopic and OS, certain limitations remain. Regional differences in surgical expertise, apparatus, and patient populations can lead to varying outcomes in other areas. The long-term effects and outcomes of both surgical techniques, particularly regarding patient quality of life, should be investigated in greater depth. Such studies would provide a more holistic perspective on the relative benefits and drawbacks of the two surgical modalities. In conclusion, while both laparoscopic and open surgical techniques have their advantages and disadvantages, our findings strongly suggested the potential superiority of laparoscopic procedures in terms of shorter operative times, shorter hospital stays, quicker recovery, and fewer complications. In determining the optimal surgical approach, it is crucial for clinicians to consider these factors, along with patient preferences and specific surgical conditions. However, it is crucial to recognize the retrospective nature of the study, and the inherent biases associated with its design. Future prospective randomized controlled trials are suggested to provide a more conclusive comparison of the two methodologies.

5. CONCLUSION:

In this retrospective cohort study comparing the outcomes of laparoscopic and OS, it was clearly demonstrated that laparoscopic procedures offered statistically significant advantages over traditional open surgeries in terms of shorter operative times, less blood loss, and shorter hospital stays following surgery. The marginally reduced incidence of SSIs was observed in the laparoscopic group. Additionally, the laparoscopic approach was associated with a quicker recovery, reduced postoperative discomfort, and fewer complications. Although surgical indications differed between groups, gallstones were notably more prevalent in the laparoscopic group. The rates of specific postoperative complications such as seroma formation, incisional hernia, and deep vein thrombosis were comparable for both techniques. However, the OS group required a greater number of follow-up visits. In addition to highlighting the significance of patient-specific factors in surgical decision-making, this study highlighted the potential advantages of laparoscopic surgery, advocating its consideration as a preferable option for certain surgical procedures.

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