J.Jpn. Surg. Soc.. 120(1): 30-36, 2019

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Feature topic

PREVENTION OF PERIOPERATIVE INFECTIOUS COMPLICATIONS OF RECTAL

In this report, we describe the perioperative management and surgical procedures with evidence to prevent surgical site infection (SSI). The incidence of SSIs in rectal cancer surgery is more frequent than in colon cancer surgery. Even laparoscopy-assisted surgery shows a similar tendency. The reason for this is the difference in the incidence of anastomotic leakage and the presence of stoma. The risk factors for SSIs in rectal cancer are conversion to open surgery from laparoscopic surgery, distance from the anal verge, and stoma construction, in addition to the risk factors for the SSIs in colon cancer surgery. The WHO guidelines recommend mechanical bowel preparation combined with oral antibiotic preparations for bowel preparation in elective colorectal surgery. Therefore, the evidence is insufficient in rectal surgery. We often construct a diverting stoma (DS) for the prevention of anastomotic leakage (AL). Although it has not been established that a DS reduces AL, it reduces the degree of peritonitis and was shown to be effective in reducing the reoperation rate. To reduce the rate of AL, prophylactic transanal drainage is an effective procedure. We use the clinical pathway to provide standard treatment and shorten the length of stay without postoperative complications. It should be determined whether the evidence is applicable to patients in each institution.

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