Drainage after cholecystectomy. A prospective randomized clinical trial.

This prospective clinical study was done to assess the efficacy of postcholecystectomy drainage. A total of 173 cholecystectomized patients were randomized into two groups; group A (86 patients) without drainage and group B (87 patients) with drainage. Group B included two types of patients; B1 (52 patients) with suction drain and B2 (35 patients) with gravity drain. Evidence of wound infection, chest complications, and duration of hospital stay were recorded in every case. Ninety five patients were assessed for chest complications and subhepatic collection by chest x-ray and abdominal ultrasonography. In group B patients the total amount of fluid drained was measured. The results were analysed by appropriate statistical methods. There was no significant difference in the rate of wound infection or atelectasis in either group, although there was apparent increase of lung complications and subhepatic collections in Group B1. The average postoperative hospital stay was significantly increased in group B patients. Considering all the parameters of this study, it was found that drainage with gravity was attended with the least morbidity.

Microbiology of postoperative wound infection: a prospective study of 1770 wounds.

A prospective study of postoperative wound infection was carried out over a 12-month period. Intra-operative swabs from the patients' anterior nares, the opened viscus and parietes were cultured using standard bacteriological techniques. Of the 1770 wounds studied, 167 (9.4%) became infected. Wound infection rates, according to clinical wound types, were clean 5.9%, clean-contaminated 10.7%, contaminated 24.3% and dirty 52.9%. The figures according to microbiological wound types were clean 4.7%, and potentially, lightly and heavily contaminated 15.3%, 22.1% and 30.2% respectively. The commonest causative organisms were Staphylococcus aureus 23.7%, Escherichia coli 16.9%, Staphylococcus epidermidis 13.5% and Pseudomonas aeruginosa 13.0%. When isolated intra-operatively, Enterobacter spp., Proteus spp., Klebsiella spp. and P. aeruginosa appeared to have a high probability of causing postoperative wound infection, but the intra-operative isolation of Bacteroides sp. was a poor predictor of subsequent wound infection.

Fistula-in-ano: A pathological study.

A review of 229 cases of fistula-in-ano in our institution has shown that nonspecific inflammatory tissue lines the majority of tracts. Epithelial lining was present in 50 cases and was encountered proportionately more frequently in subjects under 10 years of age, thus supporting a congenital origin as well as infection of anal glands, earlier proposed by other workers. Intestinal contents may have a role in the foreign body response seen in many cases. Locally endemic infectious conditions do not appear to play a significant role in the cause of the disease.

Wound infection following biliary surgery. A prospective surgery.

Biliary surgery in general, with cholecystectomy in particular, is probably the commonest major elective abdominal operation worldwide. A prospective study has been completed on 141 biliary operations in which intra-operative bile swabs were taken, and other risk factors for wound infection sought. Patients' characteristics were: males 51, females 90 (1:1.8); mean age 42.4 +/- 16 years; mean Quetelet index for adults was 32 +/- 5. The operations were: emergencies 10, simple-cholecystectomies 112, and choledochotomies (including other concomitant procedures) 29. The observed wound infection rates were: overall 7.8%, simple cholecystectomy 3.6% and choledochotomies 24.1%, figures which agree closely with the national and international literature. The infected patients consumed, on average, 7 days more in hospital than the uninfected ones. We found three major risk factors for wound infection: patients aged 40 years or older (over 4-fold), choledochotomy (over 6-fold), and microbiologically proven wound co-ntamination (9-fold). We conclude that, given the consistently low (less than 4%), incidence of wound infection following simple cholecystectomy, routine antibiotic prophylaxis in this subset is probably unjustified.

Prophylaxis against post-appendicectomy wound infection. A controlled clinical trial of intravenous (i.v.) metronidazole versus i.v. metronidazole-ampicillin-gentamicin.

A controlled clinical trial has been conducted on three doses of intravenous (I.V.) metronidazole alone and of I.V. metronidazole-gentamicin-ampicillin combined in wound infection following appendicectomy for non-perforated appendicitis. Of the 205 patients entered, 154 were evaluable. There were 118 males and 36 females (3.3:1), their mean age was 24 +/- 9.8 years, and mean Quetelet index was 23 +/- 5. The two groups were comparable in terms of seven potential risk factors: age, sex, Quetelet index, mean duration of operation, wound contamination, nasal carriage of S. aureus, and operating surgeon's rank. The over-all wound infection rate was 10.4%. There were two delayed infections in each treatment group. We found no difference between the two treatment groups in terms of wound infection and delayed wound infection. No adverse drug reaction was seen. We conclude that the two regimens are equally convenient, safe, effective, and reliable. But, metronidazole alone is the less expensive of the two.

Alimentary malignancies in Arabs in the Eastern Province of Saudi Arabia.

A study was made of 89 cases of alimentary malignancies in Arab patients in the Eastern Province of Saudi Arabia. The pattern of alimentary involvement observed was colo-rectum 43%, stomach 34%, oesophagus 19% and small intestine 4.5%. This finding was in contrast to previous studies in Saudi Arabia which had reported the upper alimentary tract, particularly the oesophagus, as the site most frequently affected. Of the patients 80% were Saudis. The male:female ratio was 3.9:1. A striking feature was the youthfulness of several patients, 44% being under fifty years of age. There were only three cases of alimentary lymphoma. Although colo-rectal schistosomiasis was a moderately frequent finding in the population studied, there was no pathological evidence to support an aetiological association between bilharziasis and large bowel malignancy.