PROPHYLACTIC ANTIBIOTICS IN GASTRODUODENA L SURGERY

The incidence of postoperative wound infections is increased up to 35% after gastroduodenal surgery, when gastric motility and acidity are d ecreased, as in case of gastric ulcer or cancer, obstruction, bleeding , antacid therapy. The endogenous flora contaminating the operative-si te consists of organisms of the oropharynx and the jejunum and include s anaerobes like bacteroides, aerobes like streptococci, staphylococci , E. coli. Antimicrobial prophylaxis is therefore indicated in these h igh risk patients. All groups of antibiotics have been used, however 1 st and 2nd generation cephalosporins are the most effective. A single dose given intravenously just before anaesthesia is recommended, a sec ond dose is advisable intraoperatively when surgery is prolonged or ma ssive blood loss occurs. Antibiotic prophylaxis is also recommended in gastric bypass surgery for obesity, but remains controversial for per cutaneous endoscopic gastrostomy.