Chronic Laparoscopic Port-Site Infection: A Systematic Review.

Abstract

Chronic laparoscopic port-site infection (PSI) is caused by non-tuberculous mycobacteria (NTM). This systematic review aimed to gather all existing information about the aetiology and management of chronic PSI. A systematic search of PubMed, Google Scholar, Cochrane, and PakMediNet databases was carried out. Ten studies were selected; eight from India and two from Pakistan. A total of 109 patients were reported to have chronic PSI. In all studies, reusable laparoscopic instruments were used, which were chemically sterilised. Clarithromycin, amikacin, ciprofloxacin, and levofloxacin were reported as the most sensitive medicines when used for a duration of three months. Additionally, 11% of cases were treated with standard first-line anti-tuberculous treatment (ATT). NTM was cultured successfully in 52% of patients. Histological examination of the excised tracts showed chronic granulomatous inflammation. The source of NTM was identified as the water used to rinse reusable instruments. Debridement or excision of infected tracts, followed by antimicrobial agents according to culture, was the most successful treatment. The use of disposable laparoscopic instruments and standard sterilisation measures can help prevent these infections. Key Words: Port-site infections, Non-tuberculous mycobacteria, Anti-tuberculous treatment.