Surgical gloves are used to prevent the transmission of micro-organisms from the surgeon’s hands to the patient and vice versa. However, it has been reported that glove perforation frequently occurred during conventional open surgeries. Although laparoscopic surgery has become widespread, few studies have addressed glove perforation in laparoscopic surgery. In this study, we investigated the incidence of surgical gloves perforation in both types of surgical approach. We investigated the incidence of perforation in 3,026 gloves (1,513 pairs) used during the gastrointestinal surgeries and found that the overall perforation rate was 10.9％. There was no significant difference between open surgery and laparoscopic surgery (11.3％ and 10.4％, respectively, P＝0.4611). When double gloves were used, the perforation rate of inner gloves (5.7％) was significantly less frequent compared to the outer gloves （5.7％ and 11.9％, respectively, P＝0.0001）. The current data demonstrated that glove perforation during laparoscopic surgery occurred at the almost same rate as open surgery, suggesting that double gloves may be useful for preventing the blood exposure and SSI in laparoscopic surgery.

It has been suggested that adding oral antibiotics (OAB) to preoperative mechanical bowel preparation (MBP) (OAMBP=MBP+OAB) has prophylactic effects for surgical site infection (SSI). This paper reports the current situation of SSI in laparoscopic colectomy through OAMBP at our department. Methods: SSIs observed is 2,003 patients who underwent elective laparoscopic colectomy with OAMBP at our department during the period from 2013 to 2017 were examined. Results: SSI was observed in 1.9％ of overall colon surgeries (22/1,184) and 7.4％ in overall rectal surgeries (61/819). Wound infections were observed in 1.8％ of colon surgeries (21/1,184) and 3.7％ of rectal surgeries (30/819). Anastomotic failure was observed in 0.1％ of colon surgeries (1/1,146) and in 4.0％ of rectal surgeries (30/753). Intra-abdominal abscess was observed in 0.1％ of rectal surgeries (1/819). Wound infection from abdominoperineal resection (APR) was observed in 36.7％ (18/49). SSI in rectal surgeries except for APR was observed in 5.5％ (42/770). The incidence rate of SSI in laparoscopic colectomy was low, and control through OAMBP was favorable. However, results suggested that further research into, and the improvement of, SSI in APR are required.

Laparoscopic colorectal surgery has a lower rate of surgical site infection (SSI) compared to open surgery. Efficacy of preoperative oral antimicrobial prophylaxis (OAP) in laparoscopic colorectal surgery is controversial. We conducted a randomized controlled trial (RCT) to test whether omitting OAP would be non-inferior to administering OAP in preventing SSI after elective laparoscopic colorectal surgery. The study revealed noninferiority of omitting OAP, with the SSI rates of 7.8％ （20/255） in the OAP group and 7.8％ (20/256) in the no-OAP group (P＝0.017). No significant differences were observed for incisional SSI and organ/space SSI between the two groups. We concluded that OAP could be safely omitted in elective laparoscopic colorectal surgery. Although recent studies suggested efficacy of OAP in colorectal cancer, we emphasize that intravenous microbial prophylaxis without OAP can achieve low incidence of SSI if proper aseptic procedures are given during laparoscopic colorectal surgery.

We report the clinical outcome of colorectal surgery without mechanical bowel preparation (MBP), in which reexamined a protocol of MBP, at Osaka National Hospital. In the first term, all cases had no MBP, the Surgical Site Infection (SSI) rate was 36.8%. In the second term, only rectal cancer had glycelin enema, the SSI rate was 17.6%. When an anastomotic leakage was happened in rectal cancer, a complication was getting severe. In the third term, rectal cancer had MBP, there are no SSI. From this result, we continued the protocol of MBP for all rectal cancer, the SSI rate was 11.2% and there were no severe cases. We decided that MBP was necessary for rectal cancer, avoiding severe complication.

Although the incidence rate of surgical site infection (SSI) after colorectal surgery in Japan has been declining, the rate is still high and needs to be improved. Evidence for preoperative bowel preparation to prevent SSI can be found in guidelines worldwide, including Japan. In summary of the major guidelines, Mechanical Bowel Preparation (MBP) combined with Oral Antibiotics Bowel Preparation (OABP) is recommended, and MBP alone is not recommended. However, in Japan, MBP combined with OABP is used only in a few institutions, and MBP alone is used in many institutions. The compliance rate of the guidelines is low.

Bowel preparation before colorectal surgery includes mechanical bowel preparation (MBP) that physically removes feces and chemical bowel preparation (CBP) that administers oral antimicrobial agents. Both MBP and CBP were performed in Japan in the 1980s for the purpose of preventing postoperative infections. However as we experienced severe MRSA enterocolitis after surgery in the late 1980s and 1990s, it was assumed that CBP that would disturb gut microbiota chould possibly be associated with the development of MRSA enterocolitis. Since then, experts and academic societies have expressed their views that CBP may not be recommended. As a result CBP performed in about 80％ of facilities in Japan in 1994 decreased to about 10％ in 2008.

In Japan since the 1980’s, severe enteritis due to the use of oral antibiotics for 2-3 days before surgery has been reported and thereafter the use of oral antibiotic prophylaxis was decreased. In recent years, many guidelines recommend the use of oral antibiotics only on the day before surgery. On the other hand, enteritis, such as Clostridoides difficile (CD), has become a global problem. According to recent RCT results, the incidence of CD infection when using preoperative oral antibiotic prophylaxis is around 0.11%. Because the use of oral antibiotics is expected to increase in the future, this paper summarizes recent findings on antibiotics associated enteritis.

A woman in her sixties received endoscopic submucosal dissection (ESD) for a laterally spreading tumor at sigmoid colon. At the day before the procedure, she had chemical bowel preparation with Kanamycin and Metronidazole. On postprocedural day 5, she complained of abdominal distention. Gradually she got a fever and watery diarrhea. On postprocedural day 10, she was diagnosed with Clostridioides difficile infection (CDI). We started Vancomycin and Metronidazole administration through nasogastric tube. But her condition was getting worse. On postprocedural day 11, we performed emergency subtotal colectomy. In this case, her inadequate administration of antibiotics may have caused the development of CDI with severe complication. We think that it is important to use antibiotics adequately for prevention of CDI. Moreover, bacteriological examination should be performed promptly in order to prevent progression to severe CDI.