Elective cholecystectomy without drainage and without prophylactic antibiotics. A prospective randomized trial with clinical and bacteriological aspects.

A consecutive series of 50 patients undergoing elective cholecystectomy without prophylactic antibiotics entered a prospective randomized trial to compare the post-operative clinical course whether the subhepatic space was drained or not. 26 patients (mean age 58 yrs) were drained and 24 patients (mean age 59 yrs) were not. The incidence of positive gallbladder bile cultures were respectively 8 and 19% (N.S.) in the drained and undrained groups. The incidence of post-operative mortality, thrombo-phlebitis and intra-abdominal sepsis was zero in both groups. In the drained or undrained series, the incidence of wound infection was respectively 4% and 0% (N.S.), that of urinary infection was 8% and 13% (N.S.) and that of pulmonary atelectasis was 15 and 17% (N.S.). A further consecutive series of 100 undrained elective cholecystectomies (18% positive bile cultures) without prophylactic antibiotics was then performed with the same uneventful postoperative course. This study therefore indicates that even in the presence of bacterobilia elective cholecystectomy can be safely performed without subhepatic space drainage and without prophylactic antibiotics.

Postoperative duodenal fistulas. A report of 23 cases with emphasis on the surgical treatment by the Roux-en-Y operation.

A series of 23 patients-15 with a spontaneous postoperative duodenal fistula and 8 with a catheter duodenostomy fistula-admitted in both departments between 1974 and 1983, is reviewed. Overall mortality rate was 9%. Using conservative management and parenteral nutrition, spontaneous closure of the fistula was observed in 78% of the cases after an average duration of 33 days. Three patients with an intractable fistula were successfully managed by surgical internal drainage using a Roux-en-Y jejunal loop. Healing time of catheter duodenostomy fistulas was similar to that of spontaneous fistulas. Therefore, deliberate creation of such duodenal fistulas should be carefully considered. The Roux-en-Y operation is recommended for those fistulas that do not heal with conservative management. The latter technique could perhaps be used primarily for the closure of difficult duodenal stumps.

[Surgical treatment of chronic pancreatitis]. / Traitement chirurgical de la pancréatite chronique.

Two cases of chronic pancreatitis treated by total pancreatectomy are reported. Diagnostic procedures and their impact on surgical strategy, the advantages and inconvenience of the different surgical techniques described in the literature are analysed in terms of mortality, morbidity and long-term results in order to define the appropriate surgical approach of the disease.