Management of severe incisional abscesses following laparotomy. Early reclosure under cover of metronidazole and ampicillin
F. Gottrup, P. Gjode, F. Lundhus, H. Andrup, C. N. Holm and S. Terpling
Department of Surgical Gastroenterology A, Aalborg Hospital, Denmark.
Patients developing severe incisional abscesses following laparotomy were
treated with incision and drainage followed by early reclosure under
antibiotic cover with metronidazole and ampicillin anhydricum. Patients
with subcutaneous abscesses were randomized into two groups that were
treated with antibiotics for one day (n = 23) or four days (n = 27). These
patients all underwent reclosure four days later. In a third group of
patients (n = 14) abscesses had developed down to, but not through, the
peritoneum. These patients received antibiotic treatment for four days and
underwent reclosure a mean of 5 1/2 days later (range, four to eight days).
No abscesses reappeared in any group and all wounds healed by first
intention. Five patients healed totally, with minor defects, but there was
no need for surgical intervention. We conclude that the early reclosure
technique is a safe procedure under antibiotic cover with metronidazole and
ampicillin. One day and four days of antibiotic treatment are equally safe
in patients with subcutaneous abscesses.
