The role of antibiotic prophylaxis for tubal microsurgery

Antibiotic prophylaxis is effective in preventing postoperative wound infections and pelvic cellulitis for a variety of gynecologic procedures. Though frequently used, there is no uniform agreement and little data descriptive of the efficacy of antibiotic prophylaxis for infertility surgery. The purpose of the present study was to determine the incidence of postoperative infection-related complications after microsurgical tubal repair for infertility and to assess the possible role (if any) of antibiotic prophylaxis for tubal surgery.

Retrospective; non-comparative; descriptive.

Three hundred and forty-eight tubal procedures were performed over a 3 1/2 year period and included tubal reanastomosis (n = 194), distal salpingostomy (n = 107), fimbrioplasty (n = 15), and tubal reimplantation and cornual isthmic anastomosis (n = 32). All procedures were performed under general anesthesia using standard microsurgical techniques. No prophylactic antibiotics were given. When used, the operating microscope was not draped. Patients were monitored postoperatively for any infection-related complications to include postoperative febrile morbidity, wound infections, and pelvic cellulitis. A computer search of discharge diagnoses and chart review was made to determine the postoperative outcome and hospital course.

There were 3 cases of febrile morbidity without localizing signs (0.8%), 3 wound infections (0.8%), 2 incisional seromas (0.5%), and one case of pelvic cellulitis (0.2%). There were no cases of bacteremia, septic shock, or septic pelvic vein thrombophlebitis. All patients responded promptly to incisional drainage or combination antibiotic therapy.

Data of the present study suggest that the incidence of infection-related complications after tubal surgery without antibiotic prophylaxis is very low. These data suggest that for tubal microsurgery where hemostasis is precise and tissue handling gentle, prophylactic antibiotics may not be necessary. Antimicrobials for prophylaxis, in these circumstances, may offer no advantage in reducing infectious complications that are already extremely low and may in fact cause unfavorable selective processes on endogenous flora and untoward side effects in selected individuals.