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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2001 December;14(6):197-204
Iatrogenic abdominal sepsis in biliary tract surgery
Caputo P. P., Zuccon W., Faccini M., Manelli A., Bonandrini L.
Background. The authors report those cases of complications linked to biliary tract surgery and the various clinical and therapeutic strategies used, in particular with regard to specific antibiotic therapy.
Methods. The study included 33 cases treated over the past 8 years. The mean age was 65 years; 21 patients were female and 12 male. Mean hospital stay was 45.5 days. Eighteen patients were admitted for emergency treatment. Of the 33 patients, 18 underwent cholecystectomy (9 traditional and 9 videolaparoscopic) for cholecysto-lithiasis (17 cases) and obstructive jaundice (1 case), 13 biliary leads for pancreatic tumours (10 choledochoduodenostomy; 3 choledochojejunostomy), and 2 patients suffering from hepatico-choledochus carcinoma underwent cholecystendesis. Twenty-seven patients underwent ERCP. The patients were treated with early or late parenteral hypernutrition depending on the onset of fever.
Results. Of the 18 cases undergoing cholecystectomy, 9 patients presented a gallbladder lesion caused by caustication (6 videolaparoscopic and 3 traditional), 6 presented open cystic ducts (3 videolaparoscopic and 3 traditional) and an anomalous biliary duct was found during traditional surgery in 3 cases. In 13 cases a biliary lead was prepared that was subsequently complicated by dehiscence of the anastomosis. Re-do surgery was required in 12 cases; one patient died.
Considerations. The authors discuss the etiopathogenetic theories responsible for these infective complications, the bacterial agents involved and the relative specific antibiotic therapies used. The antibiotic treatment of choice was either based on the use of a single drug or pharmacological association. In the majority of cases sepsis resolved when antibiotic treatment was altered on the basis of the hemoculture.
Conclusions. The study focuses on the diagnostic and therapeutic approach used, mean hospitalisation times and the medical costs. With regard to the economic savings obtained, early surgery should be preferred but does not always guarantee the patient's complete recovery. These considerations reveal how difficult it can be to compare criteria based on health spending with purely clinical criteria involving less aggressive management.