Body section

The problem of prevention of postoperative septic complications in abdominal surgery still remains relevant. This is largely due to the fact that with increasing number of complex operations with the use of modern technology increases the scope and duration of surgical interventions, increase tissue trauma and blood loss, which contribute to the development of postoperative infectious complications in the first place - wound infection. Treatment of wound infection requires additional costs and significantly increases the time of hospital stay.

Despite the increase in techniques of surgical intervention and the introduction of preventive measures, the frequency of postoperative wound infections in operations on the abdominal organs remains high. Thus, the number of postoperative suppurative complications in planned abdominal surgery is 6-8%, while, if the "clean" operations, septic complications developed in 0,8-2%, then the "dirty" or contaminated wounds suppuration number increased to 20% [39].

The frequency of suppuration of postoperative wounds in the abdominal cavity is determined by the nature of the disease, the degree of trauma surgery and the possibility of microbial infection of the wound.

When performing low-impact laparoscopic cholecystectomy incidence of postoperative septic complications is 0,6-6% [7,19,46,47], while laparotomic cholecystectomy increases to 5-26% [4,5].

In the structure of postoperative pyo-inflammatory complications is also a small percentage (1.8%) occupied and operation of selective proximal vagotomy (SPV) [32].

Increase the frequency of wound purulent complications observed after surgery with opening of hollow organs. The frequency of postoperative infectious complications increases significantly with gastric resection and varies from 4 to 26% [11.48].

The frequency of septic complications remain high during operations on the liver - 27-58% [1,6,8,23], the pancreas - 40-70% [17,29,30,54,62].

A large number (68%) of postoperative septic complications observed in surgical interventions on the colon [36]. The most serious complication of abdominal surgery is peritonitis, the incidence of which varies from 3 to 70% and the mortality rate in this case reaches 20% [4,5].

According to the report of the national surveillance system for nosocomial infections (CDC's National Nosocomial Infections Surveillance (NNIS), United States) infection of surgical intervention (SSI) is the third most frequently recorded nosocomial infection, accounting for 14 to 16% of all nosocomial infections among all hospitalized patients [ 64]. From 1986 to 1996, hospitals, conducting epidemiological surveillance of SSI within the NNIS, registered 15,523 SSI following 593,344 operations. Of this total, SSI two-thirds were located in the incision area and one third involved the organs or cavities in the surgical approach [64]. The emergence of SSI prolongs hospital stay of 10 days and increases the cost of hospitalization in 2000 dollars [56.57]. Despite significant progress in the prevention, diagnosis and treatment of surgical infection of its development in the U.S. approximately doubles the cost of hospitalization [72].

If the earlier question about the feasibility of using antibiotics prophylactically in abdominal surgery is widely debated, it is now, most researchers have concluded on the necessity and brand viagra importance of this method [9,13,21,24,27,28,34,37,39 , 42,51,63,68]. Today, antibiotic prophylaxis of postoperative infections - a common part of surgical practice in the pure-contaminated operations, as well as some clean procedures [70].

Under the prophylactic use of antimicrobials in surgery should understand prevent postoperative infectious complications by preoperative (perioperative) prescribing, with broad spectrum antimicrobial action, covering the expected pathogens in an operated organ and the surgical wound (after surgery) and provide for the creation of concentrations in the tissues, sufficient to suppress infecting microflora. Antibiotic prophylaxis reduces the number of postoperative suppuration, mortality, and reduce economic costs associated with the development of infection. At the same time, antibiotic prophylaxis of wound infection in planned abdominal surgery at the present time, many issues have not yet found a definitive answer.

In the literature [20,67,67,73] in recent years, the approaches to the standard definition of SSI, which is possible by comparing the infectious complications in any of the anatomical section of the body that have been opened or are manipulated during the operation (Table 1 and 2) and which may be the criterion for the effectiveness of perioperative prophylactic antimicrobial agents.

quantitative and qualitative
baroreflex activity
placebo
sensitivity to sodium
sympathetic activation