INFLUENCE OF BILIARY INFECTION ON POSTOPERATIVE COURSE AFTER BILIARY-TRACT SURGERY

  • 1 January 1977
    • journal article
    • research article
    • Vol. 67  (5) , 456-462
Abstract
A prospective clinicobacteriological study was undertaken in 167 patients undergoing biliary surgery to asses the possible influence of endogenous preoperative biliary infection on postoperative morbidity. Bile cultures were positive in 33% (55 patients); in those undergoing cholecystectomy alone this finding was present in 23% while in those whom a choledochotomy was performed cultures were positive in 65%. Incidence of wound infection apparently was twice as high in those undergoing choledochotomy as in those undergoing cholecystectomy alone, 37.8% vs. 18.5%. There was no appreciable difference in the rate of wound infection when a routine appendectomy was performed during biliary tract surgery. Among 38 patients with wound infection, bile cultures were positive in 16. In 13 cases the offending organism in the wound was identical with that recovered from the bile culture. An endogenous source for the wound infection was suggested. Wound infection is most likely to be encountered in patients with pathogenic organisms in the bile, in the aged and in those whose resistance to infection has been lowered by concomitant disease. The problem of septic complications following biliary tract surgery has not yet been eliminated despite strict adherence to the rules of asepsis and the use of various antibiotic agents, whether topically or systemically. There is evidence that the organisms responsible for postoperative wound sepsis are often of endogenous origin.

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