The relative significance of preoperative oral antibiotics, mechanical bowel preparation, and preoperative peritoneal contamination in the avoidance of sepsis after radical surgery for ulcerative colitis and Crohn's disease of the large bowel

Abstract

This paper reports the results of a prospective, random, controlled study of two régimes of preparation of the bowel in 100 patients undergoing elective radical surgery for non-specific inflammatory disease of the colon. Every patient received identical dietary preparation for surgery. No aperients or enemas were given in view of the inflamed state of the bowel. All patients received phthalylsulphathiazole, and in addition 50 patients chosen at random were given Colomycin. The two groups who did or did not receive Colomycin were well matched in respect of age, sex, type of operation, and steroid therapy. The addition of Colomycin to the standard régime of mechanical preparation and sulphonamides conferred no benefit to the patient in terms of postoperative complication rates. However, significantly increased rates of wound sepsis and paralytic ileus were found in patients who had a loaded colon at laparotomy or in whom faecal contamination of the peritoneal cavity occurred during operation. These results suggest that antibiotic sterilization of the large bowel, whatever its intrinsic merits, is no substitute for adequate mechanical preparation and meticulous attention to surgical technique.