Evaluation of the need of perioperative antibiotic prophylaxis at endoscopic operations in bariatric surgery. An observational study

Abstract

Purpose of the study. To determine the need for perioperative antibiotic prophylaxis in video endoscopic operations in bariatric surgery. Materials and methods. The observational study included 152 patients who underwent sleeve gastrectomy for morbid obesity — 94 (61.84 %), gastric bypass surgery — 21 (13.82 %), mini-gastric bypass surgery — 31 (20.40 %) or gastric banding — 6 (3.94 %) in the absence of PAP. All surgical interventions were performed by one team of surgeons. The average duration of the operation was 140.69 ± 35.57 minutes. The overwhelming majority of patients belonged to the average age — 44.0 ± 8.5 years (from 23 to 64 years). The average body mass index (BMI) of all patients at the time of admission was 46.57 ± 7.12. Results. It was found that the development of infections of the surgical site (SSI) without the use of antibiotics in the perioperative period was absent, the frequency of presumed infections was 4.0 % (6 out of 151). Moreover, only in 1 case, an anastomotic leak was diagnosed, in 6 cases the focus of infection was not established and antibiotics (cefoperazone / sulbactam or cefepime, or ceftriaxone) were prescribed empirically for 2–3 days based on an increase in the number of blood leukocytes and a rise in body temperature above normal values. An increase in body temperature and an increase in the number of blood leukocytes in the initial state was associated with grade 4 on the ASA scale and an operation duration of more than 180 minutes. Conclusion. During endovideoscopic surgeries for morbid obesity, perioperative antibiotic prophylaxis is justified only in patients belonging to the 4th class on the ASA scale and the estimated duration of surgery is more than 3 hours.