Evaluation of septic complications in patients undergoing biliary surgery for gall stones in a tertiary care teaching hospital of South India.

ABSTRACT

BACKGROUND: One of the etiologies of formation of gall stones is infection and bile is a good media for microorganisms to grow. Acute cholecystitis and spillage of bile intraoperatively can lead to sepsis and postoperative complications. An attempt to study the nature of organisms and their antibiotic sensitivity is important to take appropriate steps. OBJECTIVE: Present study was done to assess the rate of infected bile in patients undergoing cholecystectomy for gallstones and to study its influence on postoperative infective complications. METHODS: This prospective study was conducted over a period of two years (from July 2003 to July 2005) in a tertiary care teaching institute in South India. Bile samples of 100 patients undergoing biliary tract surgery were collected and cultured for aerobic and anaerobic bacteria. Patients were divided into two groups which included 84 cases who underwent laparoscopic cholecystectomy and 16, open cholecystectomy. All the patients received prophylactic antibiotic. RESULTS: Bile culture was positive in 8 cases. Two cases developed postoperative wound infection; however in these bile culture was sterile. No significant postoperative complications were observed in any of the group apart from 1 case that developed intra abdominal abscess along with wound infection requiring re-exploration. Six cases developed postoperative fever that subsided on its own. CONCLUSION: The overall rate of septic complications following biliary surgery was extremely low. Present study does not show any correlation between infected bile and septic complications that is in accordance with the published literature. Present study also highlights the fact that good surgical techniques and judicious use of prophylactic antibiotics are two major factors for lower incidence of septic complications, if any, after biliary tract surgery.