title: Microbiological spectrum of the intraperitoneal surface after elective right-sided colon cancer: are there differences in the peritoneal contamination after performing a stapled or a handsewn anastomosis?
abstract: BACKGROUND
  Although colonic surgery is performed with strict aseptic measures, some contamination is nearly impossible to avoid. In stapled anastomosis, the hole opened in the colon is minimum, just necessary for introducing the parts of the mechanical devices. In handsewn anastomosis, the colonic lumen is more exposed to the peritoneum, despite colonic occlusion with clamps while the suture is performed.
  
  
  METHODS
  A prospective, randomized study was performed between October 2009 and June 2011. Inclusion criteria were a diagnosis of right-sided colon cancer and having undergone an elective surgery with curative aims. The patients were divided into two groups: those patients undergoing a stapled ileocolonic anastomosis (group 1) and those undergoing a handsewn anastomosis (group 2). A microbiological sample was obtained from the peritoneal surface before opening the colon and after finishing the anastomosis in each group. Data were correlated with the wound infection and intra-abdominal infection rates.
  
  
  RESULTS
  Eighty-four patients were included in the study: 42 patients in each group. There were two intra-abdominal abscesses (5 %) in each group (NS). Wound infection rate was 10 % in group 1 and 7 % in group 2 (NS). Mean operative time was 98.8 min in the stapled group and 105.2 min in the handsewn one (P = 0.013). Positive cultures were obtained in 79 % of the cases after stapled anastomosis and 73 % after handsewn ones (NS).
  
  
  CONCLUSIONS
  Peritoneal contamination appears in over 70 % of cases after ileocolonic anastomosis. Significant differences in peritoneal contamination, wound infection, and intra-abdominal abscess between stapled and handsewn anastomoses could not be demonstrated.
authors.affiliation: Department of Surgery, General University Hospital Elche, Alicante, Spain. jruiztovar@gmail.com
authors.forename: Jaime
authors.initials: J
authors.lastname: Ruiz-Tovar
authors.forename: Jair
authors.initials: J
authors.lastname: Santos
authors.forename: Antonio
authors.initials: A
authors.lastname: Arroyo
authors.forename: Carolina
authors.initials: C
authors.lastname: Llavero
authors.forename: Alberto
authors.initials: A
authors.lastname: López
authors.forename: Andres
authors.initials: A
authors.lastname: Frangi
authors.forename: Laura
authors.initials: L
authors.lastname: Armañanzas
authors.forename: Maria Jose
authors.initials: MJ
authors.lastname: Alcaide
authors.forename: Fernando
authors.initials: F
authors.lastname: Candela
authors.forename: Rafael
authors.initials: R
authors.lastname: Calpena
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D001419:Bacteria / Q000254:growth & development*; D003106:Colon / Q000601:surgery*; D003110:Colonic Neoplasms / Q000150:complications / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D059413:Intraabdominal Infections / Q000209:etiology*; D008297:Male; D010537:Peritoneum / Q000382:microbiology*; D017792:Surgical Stapling / Q000009:adverse effects*; D016896:Treatment Outcome