Background and Purpose: One of the main benefits of minimally invasive surgery compared
with open surgery is the significant reduction in the incidence of postoperative infections.
Possible explanations include the smaller incision, minimal use of central venous catheters
for parenteral nutrition, faster mobilization, reduction in postoperative pain, and better preservation
of immune system function with a limited inflammatory response to tissue injury. We
compare the incidence of postoperative infections after the most common laparoscopic surgical
procedures with that after the corresponding open operation, and review the possible
mechanisms behind these results.
Method: Review of the pertinent literature.
Results: Several randomized controlled trials (RCTs), as well as most retrospective studies,
show a significant reduction in incisional complications with laparoscopic cholecystectomy
in comparison with open surgery (mean 1.1% vs. 4%), as well as in urinary tract and pulmonary
infections. In colorectal resection, laparoscopic surgery was characterized by a significant
reduction in surgical site infections (mean 5% vs. 9.5%), and the infections that did
occur tended to be less severe. Again, there were fewer urinary and pulmonary infections
postoperatively. Acute appendicitis represents an interesting setting to study the effect of
minimally invasive surgery on infections, as it involves a potentially contaminated field. Most
of the results confirm that the rates of surgical site (mean 2% versus 8%) and respiratory (mean
0.3% versus 3%) infections favor laparoscopic surgery, but minimally invasive surgery seems
to be characterized by a higher incidence of postoperative intra-abdominal abscess. The
laparoscopic approach to splenectomy is clearly superior to standard laparotomy in terms of
postoperative complications, including infections, although the rate of overwhelming postsplenectomy
infection (OPSI) remains similar because this complication is related more to
spleen removal than to the surgical approach.
Conclusions: Most of the literature is in agreement that laparoscopic surgery is associated
with better preservation of immune function and a reduction of the inflammatory response
compared with open surgery. The rate of postoperative infections seems to be significantly
lower.
