Assessment of bacteriological profile and wound infection in open and laparoscopic gall bladder surgery
DOI:
https://doi.org/10.18203/2320-6012.ijrms20240532Keywords:
Laparoscopic, Surgical site infection, CholecystectomyAbstract
Background: Cholecystectomy is one of the most frequent types of abdominal surgery performed in the world. Generally, there is minimal risk of serious postoperative complications. One of the complications is Surgical Site Infection, which can be caused by bile leakage and intraoperative contamination.
Methods: This prospective study was conducted in department of General Surgery, SKIMS medical college Srinagar, from June 2020 to July 2023 comprising of 100 patients. All patients undergoing the procedure were observed for wound infection.
Results: A total of 100 patients were studied with female to male ratio of 2:3. The mean age was 50.24±12.25 with 54% elderly patients. The average hospital stay was 4.02±07. 88% subjects belonged to ASA II Category with Hypertension and hyperthyroidism as common comorbidity. 11 patients got wound infection including 9 from open cholecystectomy and 02 from laparoscopic cholecystectomy with most patients belonging to elderly age group. Wound culture was positive in 9 out of 11 subjects of open cholecystectomy. E. coli was seen to be a major causal bacterial agent. Bile culture was positive in 8 patients. Both genders were almost equally affected by wound infection. Meropenem, Ceftriaxone, Gentamicin and Amikacin showed the highest number of antibiotic sensitivities tested in case of wound cultures.
Conclusions: The prevalence of positive wound culture in uncomplicated laparoscopic cholecystectomy is low as compared to open procedure. Elderly age, co-morbid patients, patients who had history of jaundice, recent history of cholecystitis were at higher risk of wound infections.
References
Langenbuch C. Ein Fall von Exstirpation der Gallenblase wegen chronischer Cholelithiasis. Heilung. In: Erste Operationen Berliner Chirurgen. Boston: DE Gruyter; 2010.
Litynski GS. Highlights in the history of laparoscopy: the development of laparoscopic techniques-a cumulative effort of internists, gynecologists, and surgeons. Barbara Berner Verlag. 1996.
Usman J, Janjua A, Ahmed K. The frequency of port-site infection in laparoscopic cholecystectomies. Pak J Med Health Sci. 2016;10(4):1324-6.
Wilson SE, Hopkins JA, Williams RA. A comparison of cefotaxime versus cefamandole in prophylaxis for surgical treatment of the biliary tract. Surg Gynecol Obstet. 1987;164(3):207-12.
Keighley MRB, Flinn R, Alexander-Williams J. Multivariate analysis of clinical and operative findings associated with biliary sepsis. Br J Surg. 2005;63(7):528-31.
Courtney M, Townsend J, Beauchamp RD, Evers BM, Matox KL. Biliary tract. In: Sabiston Text book of Surgery. 17th ed. USA: Elsevier Publication; 2005:1597-643.
Darkahi B, Videhult P, Sandblom G, Liljeholm H, Ljungdahl M, Rasmussen IC. Effectiveness of antibiotic prophylaxis in cholecystectomy: A prospective population-based study of 1171 cholecystectomies. Scand J Gastroenterol. 2012; 47(10):1242-6.
Yildiz B, Abbasoglu O, Tirnaksiz B, Hamaloglu E, Ozdemir A, Sayek I. Determinants of postoperative infection after laparoscopic cholecystectomy. Hepatogastroenterology. 2009;56(91-92):589-92.
Chang WT, Lee KT, Chuang SC, Wang SN, Kuo KK, Chen JS, et al. The impact of prophylactic antibiotics on postoperative infection complication in elective laparoscopic cholecystectomy: a prospective randomized study. Am J Surg. 2006;191(6):721-5.
Coccolini F, Catena F, Pisano M, Gheza F, Fagiuoli S, di Saverio S, et al. Open versus laparoscopic cholecystectomy in acute cholecystitis. Systematic review and meta-analysis. Int J Surg. 2015;18:196-204.
Wells GR, Taylor EW, Lindsay G, Morton L. Relationship between bile colonization, high-risk factors and postoperative sepsis in patients undergoing biliary tract operations while receiving a prophylactic antibiotic. Br J Surg. 2005;76(4):374-7.
den Hoed PT, Boelhouwer RU, Veen HF, Hop WCJ, Bruining HA. Infections and bacteriological data after laparoscopic and open gallbladder surgery. J Hospital Infect. 1998;39(1):27-37.
Donkervoort SC, Kortram K, Dijksman LM, Boermeester MA, van Ramshorst B, Boerma D. Anticipation of complications after laparoscopic cholecystectomy: prediction of individual outcome. Surg Endosc. 2016;30(12):5388-94.
Murphy MM, Ng SC, Simons JP, Csikesz NG, Shah SA, Tseng JF. Predictors of Major Complications after Laparoscopic Cholecystectomy: Surgeon, Hospital, or Patient? J Am Coll Surg. 2010;211(1):73-80.
Meijer WS, Schmitz PIM, Jeekel J. Meta-analysis of randomized, controlled clinical trials of antibiotic prophylaxis in biliary tract surgery. Br J Surg. 2005; 77(3):283-90.
Keighley MR. Micro-organisms in the bile. A preventable cause of sepsis after biliary surgery. Ann R Coll Surg Engl. 1977;59(4):328-34.
Dirksen CD, Schmitz RF, Hans KM, Nieman FH, Hoogenboom LJ, Go PM. Ambulatory laparoscopic cholecystectomy is as effective as hospitalization and from a social perspective less expensive: a randomized study. Ned Tijdschr Geneeskd. 2001; 145(50):2434-9.
Shea JA, Berlin JA, Bachwich DR, Staroscik RN, Malet PF, McGuckin M, et al. Indications for and Outcomes of Cholecystectomy. Ann Surg. 1998; 227(3):343-50.
Steiner CA, Bass EB, Talamini MA, Pitt HA, Steinberg EP. Surgical Rates and Operative Mortality for Open and Laparoscopic Cholecystectomy in Maryland. New Eng J Med. 1994;330(6):403-8.
Orlando R. Laparoscopic Cholecystectomy. Arch Surg. 1993;128(5):494.
Faraz A, Sana I. Cholelithiasis; a clinical and microbiological analysis. Int J Sci Study. 2014;2:4.
Moazeni BM, Imani R. Bacteria isolated from patients with cholelithiasis and their antibacterial susceptibility pattern. Iran Red Crescent Med J. 2013; 15(8):759-61.
Morris-Stiff GJ, O’Donohue P, Ogunbiyi S. Microbiological assessment of bile during cholecystectomy: is all bile infected? HPB. 2007;9: 225-8.
Sahu MK. Clinical and Bacteriological profiles of patients with Acute Cholangitis. Christian Med Coll J. 2009.
