Persistent Pathogens Following Minimally Invasive Surgery: Is It Time to Rethink Aldehyde-Based Disinfection?

Abstract

Atypical mycobacterial (ATM) infections have emerged as a persistent problem in minimally invasive surgery (MIS), presenting as delayed surgical site infections (SSIs) that are difficult to diagnose and treat. We retrospectively reviewed 47 patients referred to our center over an 11-year period with delayed port-site complications following laparoscopic procedures performed elsewhere. Our focus was on evaluating the link between ATM infections and sterilization practices in hospitals, while secondarily considering outcomes and implications for the prevention of the same. The mean age was 43.6 years, with a predominance of women (65.9%). The most common primary procedures were laparoscopic cholecystectomy (27.7%) and tubal ligation (23.4%). Clinical presentations included port-site sinuses (38.3%), nodules (27.7%), abscesses (25.5%), and mesh-plane collections (8.5%). Microbiological evaluation confirmed infections due to <i>Mycobacterium abscessus</i>, <i>M. fortuitum</i>, and the <i>M. avium</i> complex. A strong association was observed between ATM infections and the use of 2.45% glutaraldehyde without standardized protocols, whereas autoclaving appeared protective. Patients were treated with prolonged antibiotic therapy (clarithromycin, linezolid, and/or levofloxacin for 3-6 months), and some required surgical debridement or mesh explantation. Our findings highlight ATM as an under-recognized cause of post-laparoscopic SSIs and emphasize that aldehyde-based disinfection is inadequate against these pathogens. Autoclaving should be the preferred sterilization method, and there is an urgent need for institutional and national guidelines to standardize sterilization protocols, improve early diagnosis, and optimize management.