We carried out a prospective clinical trial of colon preparation with a regimen of oral antibiotics starting on the day before surgery. The patients were assigned to one of two groups consisting of either a mechanical preparation alone group (group 1, 45 cases) or a mechanical bowel preparation with oral antibiotics group (group 2, 38 cases). Group 2 received kanamycin and metronidazole three times on the day before surgery. Cefmetazole was administered for 3 consecutive days as prophylaxis in both groups. In a study using intraoperative mucosal swabs, the rates of group 2 patients with cultures yielding anaerobes or Gram-negative bacteria were significantly lower than those of group 1. There were no significant differences in the rates of patients with cultures yielding fungi or Gram-positive organisms. The positive culture rate in the peritoneal fluid of group 1 was also higher than that of group 2 (40%, 16%, P < 0.05). The surgical site infection rate was 18% in group 1 and 13% in group 2. Organisms isolated from the sites of postoperative infections were not identical with those from the peritoneal fluid. This relatively brief course preparation minimized the emergence of resistant strains. However, in spite of the colonic bacterial burden and the intraoperative inoculation in the patients with mechanical cleansing alone, their incidence of subsequent infections was comparable to that of patients who were administered oral antibiotics provided that the prophylactic antibiotic was administered for 3 days after surgery.

A 53-year-old woman who underwent laparoscopic cholecystectomy for acute cholecystitis was discharged from the hospital after an uneventful postoperative course. However, she developed upper abdominal pain on the 6th postoperative day and was admitted to the hospital again with a suspicion of panperitonitis. Abdominal trial top found collection of biliary ascites. Postoperative biliary injury was likely. Endoscopic retrograde cholangiography disclosed leakage of contrast material from a communicating accessory bile duct which communicated between the cystic duct and the right hepatic duct. Bile leakage due to injury of the communicating accessory bile duct after cholecystectomy was diagnosed. Endoscopic nasobiliary drainage tube was placed and the conservative therapy was successful.The communicating accessory bile duct is an anomalous biliary structure which communicates between the major bile ducts and forms a circuit with the normal bile duct. In case the cystic duct is involved in a circuit, its cutting point must be determined after branching variation of the biliary tract is confirmed by preoperative examinations including DIC-CT.