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Prevention and treatment of infection in colorectal surgery

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Abstract

The results of a personal series of clinical trials on the use of antimicrobial agents for treatment and prevention of infection in colorectal surgery are presented, together with a review of the recent literature. The studies indicate that colorectal surgery is associated with a high sepsis rate which may lead to serious complications. In elective operations, an efficient mechanical bowel preparation is extremely important if antimicrobial prophylaxis is to succeed. Short-term systemic antimicrobial prophylaxis with an agent specifically active against anaerobic bacteria is effective for elective operations. In emergency colorectal operations in which mechanical bowel preparation is not possible and the operative field is already contaminated, more prolonged antimicrobial cover is advised using a combination of agents effective against both the principal aerobic and anaerobic pathogens. In contaminated operations, wounds should also be left open to avoid synergistic infection in the subcutaneous tissues.

Résumé

Les résultats de séries personnelles d'essais cliniques concernant l'emploi des agents antimicrobiens pour traiter et prévenir l'infection au cours de la chirurgie colo-rectale sont présentés par les auteurs ainsi qu'une revue générale de la littérature récente. Ces études montrent que la chirurgie colorectale est associée très souvent avec l'infection et que celle-ci peut être la source de complications particulièrement graves. Lorsqu'il s'agit de chirurgie élective, il est capital d'associer à la phophylaxie antimicrobienne une préparation parfaite de l'intestin. L'administration très courte d'un agent anti-microbien agissant électivement sur les germes anaérobies est alors suffisante. En cas de chirurgie d'urgence lorsque l'intestin ne peut être évacué parfaitement ou que la cavité péritonéale est contaminée les agents antimicrobiens doivent être employé plus longtemps. Il est nécessaire d'associer des antibiotiques efficaces les uns sur les germes aérobies, les autres sur les germes anaérobies. En cas d'opération septique l'incision opératoire doit être laissée ouverte pour éviter l'infection du tissu cellulaire sous-cutané.

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

    M. R. B. Keighley M.S., F.R.C.S.

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  1. M. R. B. Keighley M.S., F.R.C.S.
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Keighley, M.R.B. Prevention and treatment of infection in colorectal surgery. World J. Surg. 6, 312–320 (1982). https://doi.org/10.1007/BF01653547

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