Prevention of port site infection after laparoscopic cholecystectomy for acute destructive cholecystitis in patients with I—II degree obesity

Abstract

The aim — to assess the incidence of port site infection after laparoscopic cholecystectomy and laparoscopic cholecystectomy with bacteriophage therapy for acute destructive cholecystitis.Materials and methods. The analysis of the results of treatment of 96 patients with obesity of I — II stages at the age of 37 to 67 years carried out. All patients underwent laparoscopic cholecystectomy for acute destructive cholecystitis. The average body mass index was 35.04 ± 0.2 kg/m2. In the comparison group (n = 42), the subxiphoid trocar wound was sanitized with a 0.02 % decamethoxin solution in an isotonic sodium chloride solution (decasan solution) after gall bladder extraction. In the main group (n = 54), the subxiphoid trocar wound was irrigated with therapeutic and prophylactic bacteriophages (Sextaphag, Intesti‑bacteriophage, coli protein bacteriophage, and their combination). Treatment results were evaluated by the nature and frequency of infection of the trocar wound area.Results and discussion. Infiltrate and/or seromas of trocar wounds in the comparison group have observed in one (2.4 %) patient, in the main group — in 2 (3.7 %) patients. Suppuration of the trocar wound has observed only in the comparison group — 2 (4.8 %) cases. The nature of microbial bile flora and the exudate of the abdominal cavity, its amount, the sensitivity of microorganisms to antibiotics and bacteriophages were studied. In patients with gangrenous cholecystitis and local purulent peritonitis, microbial associations prevailed (65.9 %), Pseudomonas aeruginosa, Candida strains and anaerobic flora were detected. In patients with phlegmonous form of cholecystitis, the sensitivity of Escherichia coli, Staphylococci, Streptococci, Proteas and Klebsiella to Sextaphag was 76.9 — 100.0 %.Conclusions. The bacteriophage therapy after laparoscopic cholecystectomy for acute destructive cholecystitis contributed to a reduction of port site infection incidence in the postoperative period from 8.5 to 2.4 %.