A Prospective, Multicenter, Randomized Trial for Duration of the Prophylactic Antibiotics after Elective Colorectal Surgery: 3 Days versus 5 Days

PURPOSE: The use of prophylactic antibiotics in elective colorectal surgery is essential. Although postoperative prophylactic antibiotics are recommended within 24 hr, the optimal duration of the use of prophylactic antibiotics after colorectal surgery has not yet been fully proven in Korea. The aim of this study was to compare infectious outcomes in elective colorectal cancer surgery between postoperative 3-day antibiotic therapy and 5-day therapy. METHODS: We conducted a multicenter, randomized trial of a 3-day use vs. a 5-day use of the second-generation cephalosporin cefotetan after elective colorectal surgery. The main outcome measures were the incidences of surgical site infection and all other infectious complications within 21 days after surgery. RESULTS: A total of 306 patients were enrolled. Fifty-one patients were excluded because they received additional surgery or dropped out during the study. Two-hundred fifty-five patients were analyzed in this study. The two groups were similar in terms of demographics, ASA score, tumor location, tumor stage, surgical approach (conventional open vs. laparoscopy-assisted vs. robotic-assisted), and type of operation. The incidences of surgical site infection were not significantly different between the 3-day use group (4/130 or 3.1%) and the 5-day use group (3/125 or 2.4%) (P=1.000). Incidences of overall infectious diseases did not differ significantly between the two groups. Postoperatively, both groups had similar values in their white blood cell count, absolute neutrophil count, and C-reactive protein levels. However, the number of patients is small to draw a definite conclusion in this study. CONCLUSION: Three-day cefotetan administration may be not inferior in preventing surgical site infection compared to 5-day antibiotic administration. However, further studies with a large number of patients are needed before a definite conclusion can be drawn.

Intraoperative Enteroscopic Total Polypectomy for the Patients with Peutz-Jeghers Syndrome

Patients with Peutz-Jeghers syndrome often suffer complications of the polyps, such as intussusception, bowel obstruction, and bleeding. Furthermore, repeated operations may be required in some patients, which may result in short-bowel syndrome. Intraoperative enteroscopy during a laparotomy for this syndrome was introduced. This can avert multiple enterotomies and decrease bowel resection segments. We report the cases of three consecutive patients with Peutz-Jeghers syndrome who recently underwent intraoperative enteroscopy via enterotomy with successful removal of most small-bowel polyps. The large polyps of the jejunum required an enterotomy for their removal, but smaller polyps at the lower ileum were identified and removed by using intra-operative total enteroscopy. A more complete polypectomy can be performed using this technique, thus allowing patients with Peutz- Jeghers syndrome a longer interval between laparotomies and a reduction in the symptoms attributed to polyps.