Experience with routine intraabdominal cultures during laparoscopic gastric bypass with implications for antibiotic prophylaxis

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Abstract
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. 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. 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. 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.