Oral Antiseptic Mouth Rinse Can Decrease the Morbidity Due to Surgical Site Infections in Circular Stapled Roux En Y Gastric Bypass: Single Surgeon Experience At a University Hospital

Bala Thatigotla, MD MRCS. Vanderbilt University Medical Center, Nashville,TN

Introduction:
Trans oral insertion of anvil insertion for creation of gastrojejunostomy in gastric bypass by circular stapling technique poses the increased risk of surgical site infections, because on contamination from oral and upper GI tract flora.Perioperative preventive measures can significantly decreased these infections.

Methods: This is a retrospective study of single surgeon s experience at a University hospital. Our routine technique used to be delivery of circular stapler covered with plastic bag, to avoid contact with incisions. We do not irrigate the wounds and fascia, skin are closed in routine fashion. In the recent past we have started to use Chlorhexidine 0.12% based oral rinse for our patients 1 hour before surgery. We studied total of 160[80 consecutive patient charts before use of oral rinse and 80 patients after], for comparison of surgical site infections. In all of these patients circular stapler was covered and removed from the patient abdomen

Results: The incidence of surgical site infections in the patients prior to use of antiseptic oral rinse is about 12% and after use was about 1.6%.We have noted 12% infection rate in the group without use of oral rinse in spite of circular stapler being covered. This suggests that this infection might be due to contamination of tubes and instruments while handling the anvil with oral/upper GI tract flora .This risk can be significantly decreased with this preventive technique

Conclusions: Surgical site infections can occur even when circular stapler is covered after performing gastrojejunostomy.Perioperative implementation of use of chlorhexidine 0.12% oral rinse can significantly decrease the morbidity associated with use of circular stapling device in gastric bypass.