Analysis of the Incidence and Risk Factors for Wound Infections in Open Bariatric Surgery

Christou, Nicolas V.; Jarand, Joyce; Sylvestre, Jean-Loup; McLean, A. Peter H.

doi:10.1381/096089204772787239

Cited by 73 publications

(43 citation statements)

References 19 publications

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“…23 and early, aggressive treatment with antibiotic therapy can help prevent fascial dehiscence (incidence of 1%). 9 Recurrent access port-site infection is concerning, as indicated above, and can represent an infected or eroded band.…”

Section: Wound Problemsmentioning

confidence: 99%

Complications of Bariatric Surgery: Presentation and Emergency Management – a Review

Monkhouse

Morgan

Norton

2009

annals

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Ann R Coll Surg Engl 2009; 91: 280-286 280Obesity is a world-wide epidemic 1 and is associated with multiple serious co-morbidities, both physical and psychological. Over the last decade, there has been an exponential rise in the number of bariatric procedures being offered, 2 as these have consistently been shown to be the only way to achieve sustainable weight loss and improvement in comorbidities, particularly type II diabetes and hypertension. There are many different surgical operations available to achieve weight loss; the choice of surgery depends on a number of factors, not least the experience of the surgeon and the patient's individual requirements. The predominant operation performed in the UK is the laparoscopic adjustable gastric band (LAGB), which is a purely restrictive procedure. Other procedures incorporate a malabsorptive element and include the Roux-en-Y gastric bypass (RYGB) and the biliopancreatic diversion (with or without duodenal switch; BPD, BPD/DS; Fig. 1A). Other operations include sleeve gastrectomy (Fig. 1B) which can be used as a definitive procedure or as a bridge to further by-pass surgery, and the largely historic vertical banded gastroplasty. All surgery carries some degree of risk and the decision to operate is made after a careful balance of the risks versus the benefits. This particular group of patients often have limited physiological reserves and this, together with their physical size, may make the surgery high-risk. Early detection and appropriate management of complications is crucial to prevent long-term morbidity and mortality.This review highlights the main complications that the general surgeon on-call may encounter as an emergency and illustrates the appropriate management strategies.A full literature search was carried out using PubMED and the Cochrane Library. Relevant international articles published in the last 10 years were assessed. Keywords for search purposes included bariatric, surgery, complications, emergency and management. Band-related complications Dysphagia/band slippageImmediate postoperative dysphagia is seen in some patients following LAGB. This is usually due to excessive perigastric fat resulting in a tightly fitting band or to postoperative oedema. Complete dysphagia, even for saliva, may take up to 10 days to resolve. Postoperative intravenous steroids and a strict nil-by-mouth regimen appear to increase the resolution rate for the oedema and thus hasten recovery. These patients are often in-patients until postoperative dysphagia resolves and so it is late dysphagia that more commonly The prevalence of obesity surgery is increasing rapidly in the UK as demand rises. Consequently, general surgeons on-call may be faced with the complications of such surgery and need to have an understanding about how to manage them, at least initially. Obesity surgery is mainly offered in tertiary centres but patients may present with problems to their local district hospital. This review summarises the main complications that may be encountered. MATERIALS AND M...

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Section: Wound Problemsmentioning

confidence: 99%

Complications of Bariatric Surgery: Presentation and Emergency Management – a Review

Monkhouse

Morgan

Norton

2009

annals

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“…The incidence of surgical site infections in patients operated on for obesity is high and there is a need to establish recommendations for antibiotic prophylaxis in this population (7) . For this reason, since 1997 this research group has been involved in studying safe and effective prophylaxis.…”

Section: Discussionmentioning

confidence: 99%

“…Taking into consideration that the incidence of surgical site infection in patients operated on for morbid obesity is high and the current recommendations for prophylactic antibiotics are flawed (7) , with surgical site infection tending to result in significant morbidity, it is assumed that the current prophylactic regimens probably fail to provide adequate tissue levels of the drugs in the morbidly obese. Therefore, this study was conducted to analyze the rates of surgical site infection (SSI) with three different antibiotic prophylactic regimens.…”

Section: Doi: 101590/s0004-28032015000200002mentioning

confidence: 99%

ANTIBIOTIC PROPHYLAXIS IN BARIATRIC SURGERY: a continuous infusion of cefazolin versus ampicillin/sulbactam and ertapenem

Ferraz

Siqueira

Campos

et al. 2015

Arq. Gastroenterol.

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-Background -The incidence of surgical site infection in bariatric patients is significant and the current recommendations for antibiotic prophylaxis are sometimes inadequate. Objective -The aim of this study was to analyze the effect of three prophylactic antibiotic regimens on the incidence of surgical site infection. Methods -A prospective, cross-sectional study was conducted between January 2009 and January 2013 in which 896 Roux-en-Y gastric bypasses were performed to treat obesity. The study compared three groups of patients according to the perioperative antibiotic prophylaxis administered intravenously and beginning at anesthesia induction: Group I consisting of 194 patients treated with two 3-g doses of ampicillin/sulbactam; Group II with 303 patients treated with a single 1-g dose of ertapenem; and Group III with 399 patients treated with a 2-g dose of cefazolin at anesthesia induction followed by a continuous infusion of cefazolin 1g throughout the surgical procedure. The rate of surgical site infection was analyzed, as well as its association with age, sex, preoperative weight, body mass index and comorbidities. Results -The rates of surgical site infection were 4.16% in the group treated prophylactically with ampicillin/sulbactam, 1.98% in the ertapenem group and 1.55% in the continuous cefazolin group. Conclusion -The prophylactic use of continuous cefazolin in surgeries for morbid obesity shows very promising results. These findings suggest that some prophylactic regimens need to be reconsidered and even substituted by more effective therapies for the prevention of surgical site infections in bariatric patients.

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“…As profilaxias das gastroplastias com cefazolina apresentam taxas de infecção do sítio operatório que variam de 5,6-20%, mesmo com ajustes de doses 8,16,17 . A incidência de infecção do sítio cirúrgico no tratamento cirúrgico da obesidade mórbida é alta e as atuais recomendações de antibioticoprofilaxia são falhas 8 .…”

Section: Total Pacientesunclassified

“…A incidência de infecção do sítio operatório no tratamento da obesidade mórbida é alta e as atuais recomendações de antibioticoprofilaxia são falhas 8 . Neste tipo de paciente, a infecção do sítio cirúrgico tende a apresentar significativa morbidade.…”

Section: Introductionunclassified

Profilaxia antimicrobiana na cirurgia bariátrica

Ferraz

Leão²,

Campos

et al. 2007

Rev. Col. Bras. Cir.

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OBJETIVO: Analisar os resultados da incidência de infecção do sítio cirúrgico com três diferentes esquemas antimicrobianos. MÉTODO: No período de Janeiro de 1999 a Dezembro de 2004 foram realizadas 716 cirurgias para o tratamento da Obesidade mórbida, seguindo a técnica proposta por Fobi/Capella. Foram estudados comparativamente três grupos de pacientes: Grupo I - (185) em que foi realizada a profilaxia antimicrobiana com ampicilina/sulbactam, na dose de 3g em duas doses; Grupo II (280) em que a profilaxia foi com ceftriaxona na dose de 1g (dose única); e Grupo III (251) em que a profilaxia foi com ertapenem, na dose de 1 g (dose única). RESULTADOS: O resultado do presente estudo demonstra taxas de infecção do sítio cirúrgico de 3,78% no grupo de profilaxia com ampicilina-sulbactam, 6,81% no grupo de profilaxia com ceftriaxona e de 1,99% no grupo de ertapenem. Não houve diferença estatisticamente significativa entre o uso da associação ampicilina/sulbactam ou ceftriaxona com relação à incidência de infecção do sítio cirúrgico. No entanto, quando comparados os resultados do Grupo II (Ceftriaxona) com o Grupo III (Ertapenem), houve uma diferença estatisticamente sisgnificante. CONCLUSÃO: A utilização do ertapenem, de maneira profilática, no tratamento cirúrgico da obesidade mórbida, determinou taxas de infecção do sítio cirúrgico estatisticamente inferiores ao grupo de ceftriaxona e similar ao de ampicilina-sulbactam.

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Analysis of the Incidence and Risk Factors for Wound Infections in Open Bariatric Surgery

Abstract: The incidence of wound infections following open bariatric surgery is high, and the current recommendations for antibiotic prophylaxis are ineffective. As these infections carry significant morbidity, effective methods to prevent them are needed.

Cited by 73 publications

References 19 publications

Complications of Bariatric Surgery: Presentation and Emergency Management – a Review

Complications of Bariatric Surgery: Presentation and Emergency Management – a Review

ANTIBIOTIC PROPHYLAXIS IN BARIATRIC SURGERY: a continuous infusion of cefazolin versus ampicillin/sulbactam and ertapenem

Profilaxia antimicrobiana na cirurgia bariátrica

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