INTRODUCTION An unusually high surgical site infection (SSI) rate after Roux-en-Y gastric bypass (RYGB) was noted on routine outcomes review. Surgeon A, who had a rate of 8.9%, utilized the transoral technique (passage down esophagus into gastric pouch) for anvil insertion for the circular-stapled gastrojejunostomy. By comparison, SSI rate was 0% for Surgeon B, who inserted anvil transabdominally (direct passage into stomach via gastrotomy) and used wound protection (wound protector and plastic drape over stapler). We sought to determine if it was the technique for anvil insertion (transoral or transabdominal) or use of wound protection that could help reduce SSIs. METHODS In mid-2017, Surgeon A added wound protection (wound protector and plastic drape over stapler) to the transoral technique to minimize oral flora wound contamination. Surgeon B made no changes. In this study, wound-related outcomes are examined, comparing patients who underwent surgery before (Group 1) versus after (Group 2) this intervention. Statistical analysis performed utilizing t tests and Chi square analysis; p < 0.05 considered significant. RESULTS Three hundred and thirty-three patients underwent RYGB. Group 1 consisted of 182 patients over 17 months; 151 patients over 13 months were in Group 2. Groups were similar in age, BMI, gender, and prevalence of diabetes. There was a decrease in SSIs between Group 1 and Group 2 (5 vs. 0, p = 0.04). 11 wound complications occurred in Group 1 (5 SSIs, 4 seromas and 2 hematomas); whereas 2 wound complications occurred in Group 2 (1 seroma and 1 hematoma); decrease from 6 to 1.3%, p = 0.03. CONCLUSIONS This study demonstrates that changing technique can lead to best outcomes. There was a dramatic reduction of wound complications and complete elimination of SSIs with a change in operative technique. The higher risk of SSI with the transoral anvil insertion when preforming a circular-stapled anastomosis can be mitigated with use of wound protection.

中文翻译：

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在Roux-en-Y胃旁路手术中，减少伤口感染的关键是技术或伤口保护吗？

简介在常规结局检查中注意到在Roux-en-Y胃搭桥术（RYGB）后出现了异常高的手术部位感染（SSI）率。比率为8.9％的外科医生A利用经口技术（将食道向下进入胃袋）进行了环形吻合胃空肠吻合术。相比之下，外科医生B腹腔插入砧座（通过胃切开术直接进入胃）并使用伤口保护（伤口保护器和吻合器上的塑料悬垂物）的SSI率为0％。我们试图确定是通过砧座插入（经口或经腹）技术或使用伤口保护技术来减少SSI。方法2017年中，外科医生A在经口技术中增加了伤口保护（伤口保护器和缝合器上的塑料布），以最大程度地减少口腔菌群伤口污染。外科医生B没做任何改变。在这项研究中，检查了与伤口相关的结局，比较了在本干预之前（第1组）和术后（第2组）进行手术的患者。利用t检验和卡方分析进行统计分析；p <0.05被认为是显着的。结果333例患者接受了RYGB治疗。第一组由182名患者组成，历时17个月。超过13个月的151例患者属于第2组。年龄，BMI，性别和糖尿病患病率相似。第1组和第2组之间的SSI有所降低（5比0，p = 0.04）。第一组发生11例伤口并发症（5例SSI，4例血清肿和2例血肿）；第2组发生2例伤口并发症（1例血清肿和1例血肿）；从6％降至1.3％，p = 0.03。结论这项研究表明，不断变化的技术可以带来最佳结果。随着手术技术的改变，伤口并发症显着减少，SSI完全消除。当使用环形钉吻合术时，经口砧插入会增加SSI的风险。