Modern trends in colorectal surgery

In 39 patients, the 'classical' pretreatment for colorectal surgery (mechanical purgation, laxatives, irrigation and sulfaguanidine administration) was supplemented with the oral administration of 750 mg metronidazole daily for 3 days. This dose was later increased to 1 g daily. The 75 control cases received the same pretreatment as in the test group, with the exception of the metronidazole. In the test group, obligate anaerobic pathogens could not be cultivated from the wound discharge in the infected cases, and there were no surgical fatalities. In the control group, however, anerobic strains could be cultivated in 9 cases, and the surgical mortality was 8%. The proportion of wound suppurations induced by aerobic pathogens was 41% in the test group, and 55% in the control group. The results of the metronidazole pretreatment and treatment are evaluated on the basis of the pertinent literature. The use of metronidazole is strongly advisable in the pretreatment of patients subjected to colorectal surgery and in other fields of septic surgery as well. Seven hundred and fifty five elective colorectal operations were carried out in the 11 years between 1971 and 1981, and the surgical mortality rates in the periods 1971-1977 and 1978-1981 are compared. Beside the metronidazole pretreatment, technical modifications (greater use of a stapler) and cimethidine prophylaxis were introduced in the latter period. This led to a decrease in the surgical mortality rate from 12.8% to 6.5%, and no case of fatal anaerobic sepsis occurred.