Alexis O-ring wound retractor versus traditional metal retractors for the prevention of postcaesarean surgical site infections

Background: Postcaesarean surgical site infections (SSI) remain a burden globally. The Alexis (R) O C-Section Retractor, a plastic sheath retractor known to have decreased incidence of SSIs in gastrointestinal surgery, is yet to have its efficacy established during caesarean section (CS). This study aimed to compare the differences in the rate of postcaesarean surgical wound site infections between the Alexis (R) retractor and traditional metal retractors during CS at a large tertiary hospital in Pretoria. Methods: Pregnant women scheduled for elective CS were prospectively randomised to either the Alexis (R) retractor group or the traditional metal retractor group at a tertiary hospital in Pretoria between August 2015 and July 2016. The defined primary outcome was development of SSI, and secondary outcomes comprised patients' peri-operative parameters. All participants' wound sites were observed in the hospital for 3 days before discharge and again at 30 days postpartum. Data were analysed using SPSS version 25 withp < 0.05 considered significant. Results: A total of 207 participants were involved, Alexis (R) (n = 102) and metal retractors (n = 105). None of the participants developed postsurgical site wound infection after 30 days, and there were no differences in time to delivery, total operative time, estimated blood loss or postoperative pain between the two arms of study. Conclusion: The study found no difference in participants' outcomes using the Alexis (R) retractor in comparison with the traditional metal wound retractors. We suggest that the use of Alexis (R) retractor be at the surgeon's discretion and its routine use not advised for now. Contribution: This research being the first of its kind in South Africa in which patients' clinical outcomes were compared post caesarean section from Alexis's plastic sheath group and metal retractors group in an attempt to proffer solution to the high burden of SSI. Although no difference was seen at this point, the research was pragmatic, as it was carried out in a setting with high burden of SSI. The study is going to serve as a baseline against which studies carried out in future can be compared.