How Can We Control Intraoperative Bacterial Contamination and Surgical-Site Infection During an Anterior Resection or Hartmann’s/Miles’ Operation?

Purpose Intraoperative bacterial contamination (IBC) is a major cause of surgical-site infection (SSI). Therefore, we investigated whether the ingenuity of surgical procedures could reduce the incidence of IBC/SSI. Methods Sixty patients who were surgically treated for recto-sigmoid cancer were investigated. Among these patients, the colon was transected during the early perioperative period (ET) in 29 patients and during the late period (LT) in 31 patients. Three samples for IBC were obtained from the irrigation fluid before abdominal closure (LAVAGE), the remaining cut sutures after peritoneal closure (SUTURE), and a subcutaneous swab of the wound (SUBCUT). Results The overall SSI and IBC rates were 25% and 55.2%, respectively. Patients who developed SSI had an extremely high IBC rate (85%), and IBC patients also had a high SSI rate (68%). IBC was highest in the LAVAGE (26%) followed by the SUBCUT (26%), and the SUTURE (12%). The incidence of IBC in the LT was significantly lower than that in the ET (19% vs. 55%, p < 0.01), although the incidence of SSI was similar in both IBC groups. Conclusion Shortening the exposure of the colonic mucosa decreased the incidence of IBC/SSI; thus, careful operations to minimize IBC are recommended.