How can we control intraoperative bacterial contamination and surgical-site infection during an anterior resection or Hartmann's/Miles' operation?
OBJECTIVE
Intraoperative bacterial contamination (IBC) is a major cause of surgical-site infection (SSI). Therefore, we investigated whether the ingenuity of surgical procedures could reduce the incidence of IBC/SSI.


METHODS
Sixty patients who were surgically treated for recto-sigmoid cancer were investigated. Among these patients, the colon was transected during the early perioperative period (ET) in 29 patients and during the late period (LT) in 31 patients. Three samples for IBC were obtained from the irrigation fluid before abdominal closure (LAVAGE), the remaining cut sutures after peritoneal closure (SUTURE), and a subcutaneous swab of the wound (SUBCUT).


RESULTS
The overall SSI and IBC rates were 25% and 55.2%, respectively. Patients who developed SSI had an extremely high IBC rate (85%), and IBC patients also had a high SSI rate (68%). IBC was highest in the LAVAGE (26%) followed by the SUBCUT (26%), and the SUTURE (12%). The incidence of IBC in the LT was significantly lower than that in the ET (19% vs. 55%, p < 0.01), although the incidence of SSI was similar in both IBC groups.


CONCLUSIONS
Shortening the exposure of the colonic mucosa decreased the incidence of IBC/SSI; thus, careful operations to minimize IBC are recommended.
Nishikawa
Katsunori
K
Division of Surgery, Machida Municipal Hospital, 2-15-41 Asahimachi, Machida-shi, Tokyo, 194-0023, Japan. ka2nissy@aol.com
Hanyuu
Nobuyoshi
N
Yuda
Masami
M
Tanaka
Yuujiro
Y
Matsumoto
Akira
A
Yasue
Hideharu
H
Hayashi
Takenori
T
Kawano
Susumu
S
Usuba
Teruyuki
T
Iino
Toshio
T
Mizuno
Ryouji
R
Iwabuchi
Shuuichi
S
D034841:Abdominal Cavity / Q000382:microbiology; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control; D015331:Cohort Studies; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012811:Sigmoid Neoplasms / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D013530:Surgical Wound Infection / Q000517:prevention & control*; D007507:Therapeutic Irrigation / Q000379:methods; D016896:Treatment Outcome