2. Clinical management
Antibiotic prophylaxis with cefazolin was given 30 minutes before the
incision and repeated if the operation lasted more than 3 hours.
Combined antibiotic therapy (cefazolin plus metronidazole) continued
untill the day of discharge. On the day before and the morning of the
operation, Fleet Enema 133 mL rectally was applied. Abdominal catheter
was placed in all of the patients and the drain was taken out after the
patient tolerated oral intake. Nasogastric catheter was holded in the
first 24 hours. Oral intake was restricted in the first 72 hours and
started as liquid intake and progressed day by day with the status of
the bowel movements and the gas discharge. AL was suspected if the
patient had fever and/or abdominal tenderness and/or fecal drainage from
the drain/incision/vaginal cuff. All ALs were determined either by a
contrast-enhanced computed tomography (CT) and/or intraoperative
findings. Clavien-Dingo classification was used to define the AL as
major (need of re-operation) or minor (conservative
management)5. In statistical analysis, major and minor
ALs were analyzed in the same group. Patients were allowed to discharge
if they had oral intake without vomiting, feces discharge, and no sign
of peritonitis.