- Email: [email protected]
Testimony has its merits!
MacFarlane and Ryan
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heimer MC. Wound infections after colectomy. Dis Colon Rectum 1978; 21: 567-72. Bartlett SP, Burton RC. Effects of prophylactic antibiotics on wound infection after elective colon and rectal surgery: 1960 to 1980. Am J Surg 1983; 145: 300-9. Gingold BS, Jagelman DG. Value of pelvic suction-irrigation in reducing morbidity of low anterior resection of the rectum: a ten year experience. Surgery 1982; 91: 394-7. Minervini S, Bentley S, Youngs D, Alexander-Williams J, Burdon DW, Keighley MRB. Prophylactic saline peritoneal lavage in elective colorectal operations. Dis Colon Rectum 1980; 23: 392-4. Anderson B, Korner 8, Ostergaard AH. Topical ampicillin against wound infection after colorectal surgery. Ann Surg 1972; 176: 129-32. Pello MJ, Beauregard W, Shaikh K, Camishion RC. Colon operations without wound infection: principles and techniques in 101 cases. Am Surg 1984; 50: 362-5. Gingold BS, Berardis J, Knight P. Reducing the risk of wound infection in operations upon the colon. Surg Gynecol Obstet 1984; 158: 9-12. Mcllrath DC, van Heerden JA, Edis AJ, Dozois RR. Closure of abdominal incisions with subcutaneous catheters. Surgery 1976; 80: 411-6. Sindelar WF, Mason GR. Irrigation of subcutaneous tissue with povidone-iodine solution for preservation of surgical wound infections. Surg Gynecol Obstet 1979; 148: 227-31.
11. Conolly WB, Hunt TK, Zederfeldt B, Cafferata HT, Dunphy JE. Clinical comparison of surgical wounds by suture and adhesive tapes. Am J Surg 1969; 117: 318-22. 12. Cruse PJE. Incidence of wound infections on the surgical services. Surg Clin North Am 1975; 55: 1269-75. 13. Cole WR, Bernard JR. Wound isolation in the prevention of postoperative wound infection. Am J Surg 1983; 145: 625. 14. Baker JW. Low end to side rectosigmoidal anastomosis. Description of technique. Arch Surg 1950; 61: 143. 15. Rosi PA. Selective operations for carcinomas of the colon. In: Turret1 R, ed. Disease of the colon and rectum. Philadelphia: WB Saunders, 1969; 478: 500. 16. Ruckley CV, Smith AN, Balfour TW. Perineal closure oy omental graft. Surg Gynecol Obstet 1970; 13 1: 300-2. 17. Ryan JA, Oakley WC. Cecoproctostomy. Am J Surg 1985; 149: 636-9. 18. Glotzer DJ, Boyle PL, Silen W. Preoperative preparation of the colon with an elemental diet. Surgery 1973; 75: 703-7. 19. Bornside GH, Cohn I. Stability of normal human fecal flora during a chemically defined low residue liquid diet. Ann Surg 1975; 181: 58-60. 20. Alexander JW, Fischer JE, Boyajian M, Palmquist J, Morris MI. The influence of hair-removal methods on wound infections. Arch Surg 1983; 116: 347-52. 21. Raahave D. Effect of skin wound drapes on the density of bacteria in operation wounds. Br J Surg 1976; 63: 421-6.
EDITORIAL COMMENT
Testimony Has Its Merits! Hiram C. Polk, Jr., MD, Louisville, Kentucky
It is uncommon that a testimonial experience will find favor with the increasingly stringent review applied to clinical surgical reports in this journal, as well as other journals. The foregoing article is a particular exception to that rule. It described a very favorable personal consecutive experience with a sequence of maneuvers designed to minimize certain complications after major colon surgery. The authors describe the patient population and indicate that the group consisted of an appropriate stratification of elderly, seriously ill patients with frequent associated illnesses and prevalent use of medications that might predispose to complications. The report represents, in the Editor’s opinion, a clear and explicit report on the value of multiple adjunctive procedures in the hands of a very senior surgeon over a substantial length of time. Surgical readers should appreciate that it is often a combination of such maneuvers that yield good outcomes, the foremost of which is usually sound surgical judgment and exquisite surgical technique. The authors deliberately point out that many of the fads for the control of infectious complications in colon surgery were not used by them. The authors did utilize a combination of oral antimicrobial agents and From the Department of Surgery, University of Louisville School of Medicine, Louisville,Kentucky.
486
systemic perioperative therapy, generally with proven agents. It has been difficult to show that a combination of oral and parenteral drugs is better than either one alone [I]. There are some exceptions and indirectly this paper may represent further evidence as to the wisdom of that combination. Although incompletely accepted because it is not amenable to blinded trials, the utilization of a plastic wound protector, no doubt, contributes to the good results by reducing the dose of microbes that ultimately reach the subcutaneous fat, the tissue most prone to subsequent infection [2]. This testimonial report will represent a very, very high standard for the practice of colon surgery, and the informed reader would do well to consider both the principles and the specifics described.
References 1. Coppa GF, Eng K, Gouge TH, Ranson JHC, Localio SA. Parenteral and oral antibiotics in elective colon and rectal surgery: a prospective randomized trial. Am J Surg 1983; 145: 62-5. 2. Cole WR, Bernard HR. Wound isolation in the prevention of postoperative wound infection. Surg Gynecol Obstet 1969; 125: 257-60.
The American Journal of Surgery
3.
4.
5.
0.
7.
8.
9.
10.
heimer MC. Wound infections after colectomy. Dis Colon Rectum 1978; 21: 567-72. Bartlett SP, Burton RC. Effects of prophylactic antibiotics on wound infection after elective colon and rectal surgery: 1960 to 1980. Am J Surg 1983; 145: 300-9. Gingold BS, Jagelman DG. Value of pelvic suction-irrigation in reducing morbidity of low anterior resection of the rectum: a ten year experience. Surgery 1982; 91: 394-7. Minervini S, Bentley S, Youngs D, Alexander-Williams J, Burdon DW, Keighley MRB. Prophylactic saline peritoneal lavage in elective colorectal operations. Dis Colon Rectum 1980; 23: 392-4. Anderson B, Korner 8, Ostergaard AH. Topical ampicillin against wound infection after colorectal surgery. Ann Surg 1972; 176: 129-32. Pello MJ, Beauregard W, Shaikh K, Camishion RC. Colon operations without wound infection: principles and techniques in 101 cases. Am Surg 1984; 50: 362-5. Gingold BS, Berardis J, Knight P. Reducing the risk of wound infection in operations upon the colon. Surg Gynecol Obstet 1984; 158: 9-12. Mcllrath DC, van Heerden JA, Edis AJ, Dozois RR. Closure of abdominal incisions with subcutaneous catheters. Surgery 1976; 80: 411-6. Sindelar WF, Mason GR. Irrigation of subcutaneous tissue with povidone-iodine solution for preservation of surgical wound infections. Surg Gynecol Obstet 1979; 148: 227-31.
11. Conolly WB, Hunt TK, Zederfeldt B, Cafferata HT, Dunphy JE. Clinical comparison of surgical wounds by suture and adhesive tapes. Am J Surg 1969; 117: 318-22. 12. Cruse PJE. Incidence of wound infections on the surgical services. Surg Clin North Am 1975; 55: 1269-75. 13. Cole WR, Bernard JR. Wound isolation in the prevention of postoperative wound infection. Am J Surg 1983; 145: 625. 14. Baker JW. Low end to side rectosigmoidal anastomosis. Description of technique. Arch Surg 1950; 61: 143. 15. Rosi PA. Selective operations for carcinomas of the colon. In: Turret1 R, ed. Disease of the colon and rectum. Philadelphia: WB Saunders, 1969; 478: 500. 16. Ruckley CV, Smith AN, Balfour TW. Perineal closure oy omental graft. Surg Gynecol Obstet 1970; 13 1: 300-2. 17. Ryan JA, Oakley WC. Cecoproctostomy. Am J Surg 1985; 149: 636-9. 18. Glotzer DJ, Boyle PL, Silen W. Preoperative preparation of the colon with an elemental diet. Surgery 1973; 75: 703-7. 19. Bornside GH, Cohn I. Stability of normal human fecal flora during a chemically defined low residue liquid diet. Ann Surg 1975; 181: 58-60. 20. Alexander JW, Fischer JE, Boyajian M, Palmquist J, Morris MI. The influence of hair-removal methods on wound infections. Arch Surg 1983; 116: 347-52. 21. Raahave D. Effect of skin wound drapes on the density of bacteria in operation wounds. Br J Surg 1976; 63: 421-6.
EDITORIAL COMMENT
Testimony Has Its Merits! Hiram C. Polk, Jr., MD, Louisville, Kentucky
It is uncommon that a testimonial experience will find favor with the increasingly stringent review applied to clinical surgical reports in this journal, as well as other journals. The foregoing article is a particular exception to that rule. It described a very favorable personal consecutive experience with a sequence of maneuvers designed to minimize certain complications after major colon surgery. The authors describe the patient population and indicate that the group consisted of an appropriate stratification of elderly, seriously ill patients with frequent associated illnesses and prevalent use of medications that might predispose to complications. The report represents, in the Editor’s opinion, a clear and explicit report on the value of multiple adjunctive procedures in the hands of a very senior surgeon over a substantial length of time. Surgical readers should appreciate that it is often a combination of such maneuvers that yield good outcomes, the foremost of which is usually sound surgical judgment and exquisite surgical technique. The authors deliberately point out that many of the fads for the control of infectious complications in colon surgery were not used by them. The authors did utilize a combination of oral antimicrobial agents and From the Department of Surgery, University of Louisville School of Medicine, Louisville,Kentucky.
486
systemic perioperative therapy, generally with proven agents. It has been difficult to show that a combination of oral and parenteral drugs is better than either one alone [I]. There are some exceptions and indirectly this paper may represent further evidence as to the wisdom of that combination. Although incompletely accepted because it is not amenable to blinded trials, the utilization of a plastic wound protector, no doubt, contributes to the good results by reducing the dose of microbes that ultimately reach the subcutaneous fat, the tissue most prone to subsequent infection [2]. This testimonial report will represent a very, very high standard for the practice of colon surgery, and the informed reader would do well to consider both the principles and the specifics described.
References 1. Coppa GF, Eng K, Gouge TH, Ranson JHC, Localio SA. Parenteral and oral antibiotics in elective colon and rectal surgery: a prospective randomized trial. Am J Surg 1983; 145: 62-5. 2. Cole WR, Bernard HR. Wound isolation in the prevention of postoperative wound infection. Surg Gynecol Obstet 1969; 125: 257-60.
The American Journal of Surgery