ABSTRACT
Background: antibiotic administration is an essential element for any surgical operation success, even if a prior infection was not detected. This is due to the fact that antimicrobial agents do not only act as therapy to treat preexisting infection but also as a prophylaxis which is given preoperatively to reduce the incidence of surgical site infection and as an adjunct to operative treatment which is given in the setting of operative management of infections such as secondary peritonitis or necrotizing fasciitis. Prophylactic antibiotics are also used as primary therapy when operation is not performed, such as for cellulitis, or postoperative pneumonia which indicates the significance of surgical antibiotic prophylaxis and the great importance of adhering to the right treatment protocol and guidelines
Aim of the Study: a systematic review was performed to evaluate the adherence to clinical guidelines for surgical antibiotic prophylaxis
Methods: of which fifteen studies were retrieved that fulfilled most of the inclusion requirements of being randomized controlled clinical trials
Results: 952 articles were retrieved from database, of which 15 studies were selected for selected for synthesis. 5 outcome of interest were identified, on top of which were the administration of antibiotic at the correct time and adequate discontinuation of antibiotic which ranged from 0.3% to 100%
Conclusion: the assessed studies addressed a gap in the adherence to guidelines for surgical antibiotic prophylaxis and more rigor approaches to leverage the guidelines
ABSTRACT
Background: postoperative peritoneal adhesions are common and frequent complication following abdominal and Pelvic Surgery. Adhesions can lead to bowel obstructions and infertility in women [when they develop around the reproductive organs], chronic pain which consequently results in reducing the quality of life for patients, level of energy, productivity, and increase the risk, complexity and chance of complications in subsequent surgeries. Main objective of this review is to study the implication of using the?good surgical techniques' in the prevention of postoperative adhesions
Methods: the present review included randomized controlled trials [RCTs] that investigated the different surgical technique impact on adhesion-related outcomes were identified through search in Pubmed, CENTRAL and Embase. Identified endpoints were: clinical outcomes and incidence of adhesions. The primary Identification of papers and data extraction were performed by independent researchers
Results: out of 1709 studies, there were only 21 papers eligible for a systematic review and included in the meta-analysis and qualitative assessment. None of the techniques that were compared significantly reduced the incidence of adhesive small bowel obstruction. In a small low-quality trial, the pregnancy rate increased after subserous fixation of suture knots. However, the incidence of adhesions was lower after laparoscopic compared with open surgery [relative risk [RR] 0.14; 95% confidence interval [CI]: 0.03-0.61] and when the peritoneum was not closed [RR 0.36; 95% CI: 0.21-0.63]
Conclusion: None of the specific techniques that were compared reduced the two main adhesion-related clinical outcomes, small bowel obstruction and infertility. The meta-analysis provides some evidence for the surgical principle that using less invasive techniques, introducing less foreign bodies or causing less ischemia reduces the extent and severity of adhesions