Surgical site infections (SSIs) continue to be a major concern in the Indian healthcare sector, although surgical procedures are increasingly moving towards less invasive methods. Data from the Indian Council
of Medical Research (ICMR), published early in 2025, reveal that around 1.5 million patients in India develop SSIs every year, and the overall incidence rate is about 5.2%.
Though laparoscopic or “keyhole” surgery considerably lowers the risk, as one local study reported an infection rate of only 3.3% versus an alarming 20% for open surgeries, it is crucial to understand that the risk can never be eliminated.
Addressing these infections requires a proactive approach that begins long before the first incision and continues well after the patient returns home. We speak to Dr Ranjeet Kumar Singh- Consultant Gastrointestinal Surgery at Regency Health Kanpur, to understand how to safeguard the recovery process is essential for anyone undergoing a laparoscopic procedure.
The Laparoscopic Advantage and Hidden Risks
Laparoscopic surgery is commonly praised for its reduced incision size, which by definition provides less surface area for bacterial growth. The problem with these infections, however, is that they can be misleading. A multicentric study involving prominent Indian institutes such as AIIMS Delhi and Tata Memorial Hospital revealed that approximately 66% of SSI infections are identified only after the patient has been discharged from the hospital. This “post-hospitalisation gap” highlights the need for patient awareness regarding infection prevention outside the sterile environment of the hospital.
Infections usually result from the patient’s own flora or environmental contaminants. Although private hospitals and other tertiary care centers have strict protocols in their operating rooms, it is during the transition to home care that many preventive barriers are reduced. The high humidity of the Indian climate, combined with poor hygiene practices, can provide a fertile breeding ground for harmful bacteria to grow.
Pre-Operative Optimization: The First Line of Defense
Prevention starts a few weeks before the operation, as clinical data indicate that infection rates are heavily dependent on the presence of comorbidities. To cite an example, systematic reviews published in the Journal of Health and Rehabilitation Research (2024) pinpoint diabetes mellitus as the main contributor to risk. Diabetic individuals tend to develop wound problems at a markedly greater rate than normal because of their hyperglycemia, which causes immunosuppression.
Careful regulation of blood sugar levels and optimizing nutritional conditions, particularly managing anemia, can help enhance the body’s inherent immune system. Patients are also advised to quit smoking at least two weeks before surgery because nicotine restricts blood vessels, thereby postponing the supply of necessary oxygen for the healing process.
Essential Post-Operative Care at Home
After being discharged, it is the patient’s and their caregivers’ responsibility to ensure that the integrity of the surgical site is maintained. Global and national guidelines, such as the WHO Global Guidelines for the Prevention of SSI, identify several primary activities that must be undertaken to preserve the integrity of the surgical site after discharge from hospital care.
- Antiseptic Hand Hygiene: The most common route of infection is manual contact. One should never touch incision sites or change dressings without thoroughly washing hands with an antiseptic soap.
- The Dryness Rule: For the first 48 hours, the incision should remain completely dry. While modern dressings are often water-resistant, it is safer to avoid direct showers until the surgeon confirms the wounds have sealed.
- Clothing Choices: In the Indian climate, perspiration can irritate a fresh wound. Wearing loose-fitting, breathable cotton clothing prevents friction and allows the skin to stay cool.
- Warning Symptoms: Signs such as increasing redness, localized warmth, persistent throbbing pain, or yellowish discharge must be reported to the surgical team immediately.
The Role of Post-Discharge Surveillance
The recovery time after a laparoscopy is faster, but it still requires a significant amount of discipline. Data from the ICMR surveillance indicate that surgeries lasting over 120 minutes or involving multiple procedures carry a higher risk of complications.
Even in standard gallbladder or hernia surgeries, it is essential to follow the antibiotic regimen closely. Failing to complete the full course of antibiotics can lead to antibiotic resistance, making future infections much harder to treat.
Although laparoscopy has brought about a surgical revolution in India by providing patients with speedy recovery and reduced pain, the prevention of infection is still a joint responsibility. By taking proper care of one’s health before the surgery and following strict hygiene practices afterwards, patients can make sure that their “keyhole” surgery results in a successful and complication-free return to normal life.
