Elective cholecystectomy with intraperitoneal drain. A bacteriological evaluation.

The occurrence of bacteria in 108 patients operated on with elective cholecystectomy was investigated in specimens from preoperative skin, gallbladder bile, drain wound secretion and drainage fluid. Growth of bacteria in gallbladder bile was found in 13% and in drainage fluid in 46% of the patients. The occurrence of bacteria in drainage fluid was not correlated with the operative time or the experience of the surgeon. The presence of pathogenic bacteria in the drainage fluid in our investigation was related to increased amounts of drainage fluid and to increased incidence of infectious complications (manifest or suspected intra-abdominal abscess and wound infection). Growth of bacteria analogous to those found in drainage fluid was observed in gallbladder bile (5% of the patients), in preoperative skin culture (12%) and in drain wound secretion (14%). Most of the bacteria in the drainage fluid seemed to come from an exogenic source. However, in 35% of the patients with bacteria in the gallbladder bile analogous bacteria were demonstrated in the drainage fluid. Since an increased occurrence of bacteria in gallbladder bile has been found in patients with acute cholecystitis and in patients more than 60 years of age the use of intraperitoneal drain from a bacteriological point of view could thus be limited to these groups of patients.