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Prevention of sepsis in gastroesophageal surgery

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Abstract

Sepsis is a common complication of gastric operations, particularly in hypochlorhydric patients such as those with gastroesophageal carcinoma, gastric ulcer, or if revision gastric surgery is required for bile gastritis. By contrast, the risks of sepsis are small for patients with a duodenal ulcer having a proximal gastric vagotomy. The risks of endogenous sepsis are determined by the preoperative bacterial flora of the stomach. High preoperative bacterial counts are rare if the fasting pH is less than 4.0, hence cimetidine therapy given immediately before operation could increase the risk of endogenous sepsis. Systemic antimicrobial prophylaxis with a broad-spectrum cephalosporin or penicillin is advised for all patients receiving cimetidine before operation, for all patients requiring gastric resection or revision gastric operations, and for any others in whom the preoperative gastric pH is 4.0 or more.

Résumé

L'infection vient compliquer assez souvent les interventions gastriques pratiquées pour des affections aussi diverses que le cancer gasto-oesophagien, l'ulcère gastrique ou la gastrite par reflux biliaire. En revanche le risque d'infection est faible chez les sujets qui sont soumis à une vagotomie hypersélective pour traiter un ulcère duodènal.

Les risques sont fonction de la richesse en germes du contenu gastrique. Le taux élevé d'agents infectieux est rarement constaté lorsque le pH est inférieur à 4 encore que l'administration de cimétidine avant l'intervention puisse augmenter les risques d'infection endogène. C'est la raison pour laquelle l'antibiothérapie préventive à large spectre avec de la céphalosporine ou de la pénicilline est à conseiller chez les malades soumis au traitement par la cimétidine dès lors qu'ils doivent subir une résection gastrique. Cette attitude s'applique aux malades dont le pH est égal ou supérieur à 4.

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  1. The General Hospital, Steelhouse Lane, B4 6NH, Birmingham, UK

    T. J. Muscroft & S. A. Deane

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  1. T. J. Muscroft
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  2. S. A. Deane
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Muscroft, T.J., Deane, S.A. Prevention of sepsis in gastroesophageal surgery. World J. Surg. 6, 293–300 (1982). https://doi.org/10.1007/BF01653544

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