ROUTINE DRAINAGE IN CHOLECYSTECTOMY - BACTERIOLOGIC AND CLINICAL-ASSESSMENT

A prospective study was carried out to determine the possible role of exogenous and endogenous bacteria in the development of postoperative complications in patients in whom drainage was routinely employed after cholecystectomy. In 100 patients undergoing cholecystectomy because of cholelithiasis, cultures were made of specimens taken from the bile during operation and from the drains. Bile cultures were positive in thirty-eight patients. Drain cultures were positive in thirty-five patients, with most of the bacteria cultured being from an exogenous source (in most cases staphylococcus). The rate of postoperative complications was found to be significantly higher in the group with positive bile cultures (of endogenous origin) than in the group with positive drain cultures (of exogenous origin) or sterile cultures. In the patients with positive bile cultures, the rate of wound infection was 31 per cent, whereas in those with positive drain cultures it was 5.7 per cent, and in those with sterile drains only 4 per cent. These findings indicate that if the bile is not infected, the risk of wound infection is considerably reduced and that the bacteria of exogenous source do not play a prominent role in the development of postoperative complications. In consideration of this as well as the fact that the use of a drain may obviate the need for reexploration in patients in whom there is postoperative leakage of bile or blood, routine drainage should not be rejected categorically in clean" abdominal operations. © 1979."