Selective decontamination of the gastrointestinal tract in patients undergoing esophageal resection

BMC Surgery

Research Article

Franziska Näf¹  Walter Kolb¹  René Warschkow¹  Jochen Lange¹  Michael Zünd¹  Thomas Steffen¹ 

[1] Department of Surgery, Kantonsspital St. Gallen (KSSG), CH-9007, St. Gallen, Switzerland;

关键词: Anastomotic Leakage;    Total Gastrectomy;    Pulmonary Infection;    Esophageal Resection;    Anastomotic Insufficiency;   

DOI  :  10.1186/1471-2482-10-36

 received in 2010-03-23, accepted in 2010-12-16,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundSelective decontamination of the digestive tract (SDD) to eliminate gram-negative bacteria is still not widely accepted, although it reduces the incidence of nosocomial infections. In a previous retrospective study, a clear benefit to perioperative morbidity, and a reduction in nosocomial infections were found in patients who underwent an esophageal anastomosis. Thus, SDD was applied routinely for esophageal anastomoses. We report the outcome of a cohort of 81 patients who underwent this treatment.MethodsFrom 2002, patients who underwent an esophageal anastomosis (esophagojejunostomy) were prospectively recorded. Perioperatively, patients received polymyxin, tobramycin, vancomycin and nystatin by mouth four times a day. Outcome was compared to a control group that was treated before 2002 (68 patients without SDD and 53 patients with SDD). Postoperative morbidity and mortality were assessed.ResultsBetween 2002 and 2007, 81 patients who underwent an esophageal anastomosis received SDD. Compared to a retrospective control group, patients with SDD had significantly less pneumonia (OR 0.06 (0.01-0.46), p < 0.001) and lower morbidity (OR 0.16 (0.05-0.49), p < 0.001). Furthermore, fewer anastomotic insufficiencies and complications were found. Similar results were found in the analysis of the patients treated before 2002.ConclusionsSDD significantly reduces perioperative morbidity and mortality in patients who undergo a distal esophageal anastomosis compared to a historical control group. In patients with an anastomotic leakage, there was a strong tendency of SDD to reduce postoperative mortality.

【 授权许可】

Unknown   
© Näf et al; licensee BioMed Central Ltd. 2010. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.