Specimen Retrieval Bag in Laparoscopic Sleeve Gastrectomy does not Reduce Wound Complications

Jingjing L Sherman, MD, Dani O Gonzalez, MD, James Yoon, BA, Edward Chin, MD, Subhash Kini, MD, Daniel Herron, MD, William Inabnet, MD, Scott Q Ng, MD. Mount Sinai

Introduction: Obesity has been demonstrated to be a risk factor for surgical site infections in certain procedures. Laparoscopic sleeve gastrectomy is a clean contaminated procedure with wound infection rate of about 1%. Wound infections after bariatric surgery are no longer reimbursed by the Center for Medicare and Medicaid Services. The use of a specimen retrieval bag in a laparoscopic sleeve gastrectomy may help prevent wound infections. We performed a retrospective study to determine whether these devices help to decrease wound complications after laparoscopic sleeve gastrectomy.

Methods: A bariatric database from Mount Sinai Hospital between January 2008 and December 2012 was retrospectively analyzed to identify patients who underwent laparoscopic sleeve gastrectomy. Patients were divided into Group 1, where a specimen retrieval bag was utilized, and Group 2, where the specimen was directly retrieved through the largest incision. Demographics, preoperative comorbidities, intraoperative variables and post-operative outcomes were compared between the two groups using Chi -square and student t-tests.

Results: A total of 239 patients underwent primary laparoscopic sleeve gastrectomy, with 37 patients in Group 1 and 202 in Group 2. There were no differences in sex, age, BMI, ASA and comorbidities between groups. All patients received preoperative prophylactic antibiotics. There was no difference in wound infection between Group 1 and Group 2, 0% and 0.5%, respectively (p=1). There was no difference in trochar site hernia between the Group 1 and Group 2, 0% and 1%, respectively (p=1). Operative time and length of stay were not different between the two groups. Other complications including bleeding, death and readmission were similar between the two groups.

Conclusions: Specimen retrieval bags do not appear to prevent wound infections in laparoscopic sleeve gastrectomy patients. Randomized studies are necessary in order to determine their value for this use.