From the Guidelines
Leakage at a laparoscopic incision site indicates a potential surgical site infection (SSI) or fascial dehiscence, requiring prompt assessment and management to prevent serious complications. The type of leakage, whether serous fluid, blood, or enteric contents, guides the initial approach. For minor serous drainage, applying pressure dressings and monitoring closely is appropriate 1. However, for more significant leakage, cleaning the wound with sterile saline solution and exploring the wound under sterile conditions to identify the source is necessary. If fascial dehiscence is present, surgical repair with non-absorbable sutures may be necessary. The use of triclosan-coated suture, as suggested by recent guidelines 1, significantly reduces SSI prevalence compared to non-coated sutures, and should be considered in the management of leakage.
Key management steps include:
- Assessing the type of leakage
- Applying pressure dressings for minor serous drainage
- Cleaning and exploring the wound for more significant leakage
- Surgical repair with non-absorbable sutures for fascial dehiscence
- Prescribing appropriate antibiotics for superficial wound infections
- Daily wound care with dressing changes
- Immediate surgical re-exploration for enteric content leakage suggesting bowel injury
Preventive measures, such as proper fascial closure during the initial procedure, particularly for ports ≥10mm, using appropriate suture material and technique, are crucial in reducing the risk of leakage and subsequent complications 1. Addressing leakage promptly is essential to prevent serious complications such as peritonitis, sepsis, or evisceration.
From the Research
Leakage at a Lap Incision
Leakage at a laparoscopic incision site can be an indication of a serious complication, such as a bowel injury or perforation. The management steps for leakage at a laparoscopic incision site include:
- Recognizing the signs and symptoms of a bowel injury, such as severe, single trocar site pain, abdominal distention, diarrhea, and leukopenia, which can occur within 96 hours of surgery 2
- Identifying the cause of the leakage, which can be mechanical or ischemic in nature, and may be related to technical or patient-related factors 3
- Implementing preventive measures, such as using a bougie size ≥40 Fr, beginning the gastric transection 5-6 cm from the pylorus, and reinforcing the staple line with buttress material, to reduce the risk of leakage 3
Management of Leakage
The management of leakage at a laparoscopic incision site may involve:
- Surgical repair of the bowel injury or perforation, which may require laparotomy 2
- Antibiotic therapy to prevent or treat wound infections, with consideration of the wound penetration of different antibiotics, such as vancomycin, ciprofloxacin, and piperacillin/tazobactam 4
- Negative pressure wound therapy (NPWT) to promote wound healing and prevent infection 4
- Judicious use of antibiotics to avoid overuse and resistance, particularly in chronic wound infections 5
- Consideration of the type of antibiotic prophylaxis used, with narrow-spectrum antibiotics potentially offering an advantage in terms of prophylaxis and hospital costs 6