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Experience with routine intraabdominal cultures during laparoscopic gastric bypass with implications for antibiotic
1Videoscopic Institute of Atlanta, P.C., 140 Vann Street, Suite 350, 30060, Marietta, GA, USA, Mikedon4@aol.com
Background:
Techniques for laparoscopic Roux-en-Y gastric bypass that do not use bowel cross-clamping raise a question of increased risk for infectious complications. However, to the authors' knowledge, no studies have recorded routine intraoperative peritoneal cultures. This article reports the authors' experience with routine peritoneal cultures during laparoscopic Roux-en-Y gastric bypass and the role of antibiotic prophylaxis.
Methods:
From January 2000 to March 2000, 66 consecutive patients undergoing a laparoscopically divided proximal Roux-en-Y gastric bypass had peritoneal fluid aspirated for routine culture. No mechanical or oral antibiotic bowel preparation was used. All the patients received preoperative intravenous antibiotic prophylaxis with Levoquin 500 mg and Flagyl 500 mg. Peritoneal fluid was aspirated from the left gutter near the site of the enteroenterostomy before irrigation with 1,000 ml of normal saline containing 50,000 U of bacitracin and 1 of kanamycin.
Results:
The follow-up period averaged 9 months for 100% of patients. For 15 patients (22.7%), the culture results were positive. The 22 organisms cultured involved 15 streptococcus species, 4 anaerobes, 2 staphylococcus species, and 1 enterobacter. None of the patients experienced a clinical infection or required an extension of antibiotics beyond the first 24 h.
Conclusions:
This study demonstrated frequent peritoneal contamination during laparoscopic gastric bypass. Prophylactic intravenous antibiotics and antibiotic irrigation may have reduced the risk of clinically significant infections in this small uncontrolled series.
Insights
Routine intraoperative peritoneal cultures during laparoscopic gastric bypass revealed frequent contamination. However, prophylactic antibiotics and irrigation appeared to prevent clinical infections in this study.
Area of Science:
- Bariatric surgery
- Minimally invasive surgery
- Surgical infectious complications
Background:
- Laparoscopic Roux-en-Y gastric bypass (LRYGB) techniques without bowel clamping raise concerns about infectious risks.
- No prior studies have documented routine intraoperative peritoneal cultures in LRYGB.
- This study investigates peritoneal cultures and antibiotic prophylaxis in LRYGB.
Purpose of the Study:
- To assess the incidence of bacterial contamination in the peritoneal cavity during LRYGB.
- To evaluate the role of antibiotic prophylaxis in preventing infectious complications after LRYGB.
Main Methods:
- 66 patients undergoing LRYGB had peritoneal fluid cultured intraoperatively.
- No mechanical or oral antibiotic bowel preparation was used.
- Patients received intravenous antibiotics (Levoquin and Flagyl) preoperatively and antibiotic irrigation during surgery.
Main Results:
- 22.7% of patients had positive peritoneal cultures, with various bacteria identified.
- No patients developed clinical infections.
- No patients required extended antibiotic treatment beyond 24 hours.
Conclusions:
- Peritoneal contamination is common during LRYGB.
- Prophylactic intravenous antibiotics and intraoperative irrigation may mitigate the risk of significant infections.
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