The results of colonic anastomoses at the Royal Melbourne Hospital

Effects of prophylactic antibiotics on wound infection after elective colon and rectal surgery: 1960 to 1980

Wound infection continues to be a common complication of elective colon and rectal surgery. During the period from 1960 to 1980, 42 prospective, controlled prophylactic antibiotic trials were undertaken which addressed this problem. In this report we have analyzed these trials and compared them to all noncontrolled, prospective wound infection surveys and a representative sample of the retrospective surveys of the same period. From this analysis several conclusions have become apparent: (1) wound infection remains a common complication for which prophylactic antibiotics are generally effective, (2) the most effective agents are those with activity against anaerobic bacteria, (3) orally administered nonabsorbable antibiotics have little effect on reducing wound infection following these procedures, and (4) the optimal antibiotic regimen is yet to be found. The data do suggest, however, the more preferred regimens currently available as well as those worthy of further investigation.

Criteria audit of surgery for carcinoma of the large intestine in Melbourne teaching hospitals

A criteria audit of patients undergoing surgery for carcinoma of the large intestine in three Melbourne teaching hospitals revealed a considerable variation in the degree of compliance with individual criteria, and a high complication rate with approximately two-thirds of the patients suffering one or more complications. The uniform system of data gathering used provides a baseline for future studies.

Anastomotic integrity after operations for large-bowel cancer: a multicentre study

Clinically evident anastomotic dehiscence was studied in 1466 patients who had undergone resection of a large-bowel adenocarcinoma. The overall incidence of anastomotic leakage was 13%, but the incidence varied between surgeons (range 0.5% to over 30%). Morbidity and mortality were significantly higher in those patients in whom the anastomosis failed to heal primarily. If these results are extrapolated to the national level, it should be possible by achieving results closer to those in patients without leakage to reduce overall post-operative mortality after resection of large-bowel cancer by 2% and to achieve an appreciable reduction in morbidity. Both factors are clinically important and, taken together, could result in appreciable saving of revenue.

Single-dose parenteral antibiotics as prophylaxis against wound infections in colonic operations

A study of 77 patients undergoing elective operations on the colon and rectum, where wounds were subject to contamination by fecal flora, did not demonstrate that the addition of a preoperative oral regime to parenteral antibiotics alone further decreased the incidence of wound infection. The authors feel that the use of single-dose clindamycin and cephazolin intravenously preoperatively has been shown to be a very effective method of preventing wound infection in elective colonic resections.