[Prevention of infections in surgery of the colon]

Abstract

The value of perioperative antibiotic prophylaxis in colorectal surgery is undisputed, since for the first time the rate of wound healing disorders could be reduced from 30 to 50% previously to less than 10%. In 3 prospectively randomized studies different kinds of prophylaxis were tested: short-time prophylaxis over 48 hours, ultra-short time prophylaxis over 24 hours, "one-shot" administration during surgery. The effective spectrum of the used cephalosporines should affect aerobic as well as anaerobic pathogens, as septic complications are caused by intraoperative bacterial dissemination. Cephalosporines such as Cefoxitin, Lamoxactam and Cefotaxime having sufficiently high serum and tissue levels at the time of enterotomy, may be used successfully as a perioperative antibiotic prophylaxis. "One-shot" administration in 100 patients has led to a drastic reduction of wound healing disorders to 4% (four mild wound healing disorders, four anastomotic leaks (9.4%). We prefer the perioperative antibiotic "one-shot" administration not only for this reason, but also because of the lowered possibility for the development of resistances and bacterial selection.