Background

Surgical site infections (SSI) are the most common complication after laparoscopic roux-en-Y gastric bypass (RYGB), especially when a circular stapler is used. O-ring retractors have been shown to decrease rate of SSI for general surgical and colorectal procedures. We evaluated the rate of SSI before and after we began using the Alexis wound retractor (AWR) for RYGB.

Methods

Patients undergoing primary RYGB with circular stapler-constructed gastrojejunostomy were selected from operative logs at Montefiore Medical Center for two time periods: August 1 2016–July 31 2017 (PRE) and August 1 2018-present (POST). We will continue to collect data and include patients until July 31, 2019. AWR was used inconsistently through the 2018-2019 academic year. Time periods were selected to ensure all patients in PRE cohort underwent RYGB without AWR and all patients in POST cohort underwent RYGB with AWR. Primary endpoints was superficial SSI. Operative time, length of stay (LOS) and 30-day morbidity and mortality were also assessed.

Results

A total of 177 patients underwent RYGB, including 105 in PRE cohort and 72 in POST cohort. Demographics were similar between groups. Six of the 105 (5.7%) PRE patients had superficial SSI. Thus far, one of the 72 patients (1.4%) in POST cohort have suffered superficial SSI. Operative time and LOS were similar.

Conclusions

Use of the Alexis wound retractor significantly reduced the rate of superficial SSI for patients undergoing RYGB with circular stapler-constructed gastrojejunostomy. Utilization does not significantly increase OR time and can decrease morbidity and cost associated with SSI.