title: Prevention of early infective complications after laparoscopic splenectomy with the Garamycin sponge.
abstract: BACKGROUND
  Surgical site infection (SSI) appear to be more frequent in splenectomized patients than might be expected and its incidence can be explained neither by the extent of surgery nor by the risk of bacterial contamination of the operating field.
  
  
  OBJECTIVE
  Evaluation the local antibiotic prophylaxis using a gentamicin surgical implant in order to reduce SSI, particularly subphrenic abscesses.
  
  
  METHODS
  WE CONDUCTED A PROSPECTIVE, RANDOMIZED STUDY OF TWO GROUPS OF PATIENTS UNDERGOING LAPAROSCOPIC SPLENECTOMY WHO WERE CONSIDERED AT HIGH RISK OF INFECTIVE COMPLICATIONS: patients with idiopathic thrombocytopenic purpura (ITP) pre-treated chronically with systemic steroids and patients with non-Hodgkin lymphoma (NHL). Out of 98 laparoscopic splenectomies performed during the study period, 40 patients with ITP and 20 with NHL met the inclusion criteria and were enrolled in the study. In 20 randomly selected patients with ITP and 10 with NHL, a gentamicin-collagen implant was left in the splenic bed.
  
  
  RESULTS
  Infective complications occurred in 4 (6.67%) among 60 patients from the entire study group; 2 in patients with ITP and a gentamicin implant who developed fever of unknown cause which resolved after systemic antibiotics, and 2 in patients with NHL and gentamicin prophylaxis who developed a subphrenic abscess. In all patients operated on without a gentamicin implant, the postoperative course was uncomplicated.
  
  
  CONCLUSIONS
  Gentamicin surgical implants not only fail to reduce the risk of subphrenic abscesses in splenectomized patients, but may contribute to the increase in its incidence, which puts into question the possible benefits of this form of prophylaxis.
authors.affiliation: 2  Department of General Surgery, Medical College Jagiellonian University, Krakow, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Migaczewski
authors.forename: Anna
authors.initials: A
authors.lastname: Zub-Pokrowiecka
authors.forename: Piotr
authors.initials: P
authors.lastname: Budzyński
authors.forename: Maciej
authors.initials: M
authors.lastname: Matłok
authors.forename: Andrzej
authors.initials: A
authors.lastname: Budzyński