Surgical Measures to Reduce Infection in Open Colorectal Surgery

Post-operative infection is an important complication of colorectal surgery and continued efforts are needed to minimize the risk of infection. A better understanding about susceptibility to infections will explain why a patient with minimal bacterial contamination at surgery may develop a pelvic abscess whereas another patient with massive faecal contamination after stercoral perforation of the colon may not develop infective complications. The most important factor in determining post-operative sepsis is the presence of viable organisms in the surgical field prior to wound closure. This review focuses on aspects of operative techniques that reduce infection in colorectal surgery. Despite antibiotic prophylaxis and therapy, the inadequate attention to technique and incorrect surgical decision making (i.e. surgeon-related factor) remain the single most important factor that can influence the morbidity and mortality from sepsis in colorectal surgery.