Wound Infection and Incisional Hernia

Barry Salky, MD FACS

Franz W. Sichel Professor of Surgery

Division of Laparoscopic Surgery

The Mount Sinai Hospital

New York

Wound Infection and Incisional Hernia

The incidence of wound infection and incisional hernia has decreased dramatically since the introduction of minimally invasive techniques.

Wound Infection and Incisional Hernia

Risk factors: • vertical incision• acute surgery• infection• corticosteroids• male gender• smoking

Wound Infection and Incisional Hernia

Does means of access into the abdomen affect the incidence of hernia formation after bowel resection?

Dupree et al

J Am Coll Surg, 2003

Wound Infection and Incisional Hernia

716 patients

2.4% laparoscopic

12.9% open

P.00002

Dupree et al

J Am Coll Surg, 2003

Wound Infection and Incisional Hernia

“Incisional hernia after open versus laparoscopic sigmoid resection”

1995-2004

3.4% laparoscopic

14.7% open p .02

Andersen et als

Surg Endosc 2008

Wound Infection and Incisional Hernia

Can we do anything to decrease the incidence besides the precautions we already take?

Wound Infection and Incisional Hernia

Learn how to be proficient with intracorporeal suturing and knot tying. That will decrease the conversion rate. Converting cases with enterotomy will increase the wound infection rate, and, thereby,

the incidence of incisional hernia.

QuickTime™ and aH.264 decompressor

are needed to see this picture.

Wound Infection and Incisional Hernia

• Antibiotics one hour pre op for clean/contaminated and contaminated wounds. Redose appropriately• Protect the extraction site with plastic barrier.• Hemostasis of wound.

Wound Infection and Incisional Hernia

• Copius irrigation with saline. Remove all devitalized fat.• Be gentle with the subcutaneous fat.• Strongly consider secondary closure in contaminated wounds.

Wound Infection and Incisional Hernia

In general, the smaller the incision, the less likely the incisional hernia rate. Welcome to laparoscopic surgery!

SAGES & CAGS host the 12th

World Congress of Endoscopic

Surgery

April 14 - 17, 2010Gaylord National Resort and Convention Center

Landover, MD (just outside Washington, DC)

Registration & Program Information

will be available Summer, 2009

Program Chairs:

Barry Salky, MD

(SAGES Chair)

Daniel Herron, MD

(SAGES Co-Chair)

Christopher Schlachta, MD

(CAGS Chair)

Hosted by SAGES & CAGSSociety of American Gastrointestinal and Endoscopic Surgeonsand Canadian Association of General Surgeons