title: How can we control intraoperative bacterial contamination and surgical-site infection during an anterior resection or Hartmann's/Miles' operation?
abstract: 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.
authors.affiliation: Division of Surgery, Machida Municipal Hospital, 2-15-41 Asahimachi, Machida-shi, Tokyo, 194-0023, Japan. ka2nissy@aol.com
authors.forename: Katsunori
authors.initials: K
authors.lastname: Nishikawa
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Hanyuu
authors.forename: Masami
authors.initials: M
authors.lastname: Yuda
authors.forename: Yuujiro
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Akira
authors.initials: A
authors.lastname: Matsumoto
authors.forename: Hideharu
authors.initials: H
authors.lastname: Yasue
authors.forename: Takenori
authors.initials: T
authors.lastname: Hayashi
authors.forename: Susumu
authors.initials: S
authors.lastname: Kawano
authors.forename: Teruyuki
authors.initials: T
authors.lastname: Usuba
authors.forename: Toshio
authors.initials: T
authors.lastname: Iino
authors.forename: Ryouji
authors.initials: R
authors.lastname: Mizuno
authors.forename: Shuuichi
authors.initials: S
authors.lastname: Iwabuchi
mesh_terms: 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