INFECTIONS AND BACTERIOLOGICAL DATA AFTER LAPAROSCOPIC AND OPEN GALLBLADDER SURGERY

In two hospitals 637 patients undergoing cholecystectomy between June 1989 and June 1993 were entered into a prospective audit. The aim of t his study was to determine the incidence of postoperative infections, especially wound infections, after open and laparoscopic biliary surge ry and to assess the bacteriological data on these patients. The incid ence of minor wound infection was 10.4% (66/637), of major wound infec tion 3.6% (23/637) and the overall incidence was 14% (89/637). The inc idence of wound infection after laparoscopic cholecystectomy was 5.3% (10/189) and all were minor. Significant specific risk factors for dev eloping a wound infection after laparoscopic cholecystectomy were emer gency of the operation (P=0.046) and acute cholecystitis (P=0.014). Ov erall, bile cultures were positive in 22%. There were 85 patients (13. 3%) with positive bile from the gallbladder. From the laparoscopically operated patients 2.8% had a positive bile culture. The predominant m icro-organisms from gallbladder bile were Escherichia coli (56 isolate s), Klebsiella spp. (20 isolates) and Streptococcus spp. (16 isolates) . There was no relationship between positive gallbladder cultures and wound infection. The consequences of wound infections can be serious a nd this study showed a morbidity rate comparable with the literature. The incisions used in laparoscopic gallbladder surgery are less suscep tible to major problems. This combined with the significantly lower in cidence of wound infections after laparoscopic cholecystectomy suggest s that routine antibiotic prophylaxis as recommended for biliary surge ry in general is now questionable.