Impact of Bariatric Surgery on the Pharmacokinetics Parameters of Amoxicillin The effect of bariatric surgery on the direct oral anticoagulant rivaroxaban: the extension study. A randomised controlled trial evaluating the use of enteral nutritional supplements postoperatively in malnourished surgical patients Intestinal absorption in patients after cardiac surgery [Effectiveness of a recruitment manoeuvre and positive end-expiratory pressure on respiratory mechanics during laparoscopic bariatric surgery]. A pilot study to determine the effectiveness of different amoxicillin regimens in implant surgery. Antibiotic Pharmacodynamics in Surgical Prophylaxis: an Association between Intraoperative Antibiotic Concentrations and Efficacy Single preoperative dose versus long-term prophylactic antibiotic regimens in dental implant surgery. Bariatric Surgery May Improve Employment Status in Unemployed, Underserved, Severely Obese Patients A pilot study investigating the efficacy of postoperative dietary counseling to improve outcomes after bariatric surgery. Nonopioid versus opioid based general anesthesia technique for bariatric surgery: A randomized double-blind study Perioperative synbiotic therapy in elderly patients undergoing gastroenterological surgery: a prospective, randomized control trial. Changes in Gut Microbiota Composition after Bariatric Surgery: a New Balance to Decode Probiotic Supplementation in Morbid Obese Patients Undergoing One Anastomosis Gastric Bypass-Mini Gastric Bypass (OAGB-MGB) Surgery: a Randomized, Double-Blind, Placebo-Controlled, Clinical Trial Effect of bariatric surgery on airway response and lung function in obese subjects with asthma. Educational Antimicrobial Stewardship Intervention Ineffective in Changing Surgical Prophylactic Antibiotic Prescribing. Determinants of postoperative infection after laparoscopic cholecystectomy.
Background Bariatric surgery leads to several anatomo-physiological modifications that may affect pharmacokinetic parameters and consequently alter the therapeutic effect of drugs , such as antibiotics . The pharmacokinetics of oral amoxicillin after Roux-en-Y gastric bypass ( RYGB ) surgery is unknown . Objectives The objective of this study was to evaluate the impact of bariatric surgery on the pharmacokinetics of  amoxicillin . Methods This study was performed as a r and omized , open-label , single-dose clinical trial , with two periods of treatment , in which obese subjects ( n = 8) received an amoxicillin 500 mg capsule orally before and 2 months after the RYGB surgery . The  amoxicillin plasma concentration was determined by liquid chromatography coupled to mass spectrometry ( LC-MS/MS ) . Results After the surgery , the mean weight loss was 17.03 ± 5.51 kg , and mean body mass index ( BMI ) decreased from 46.21 ± 2.82 to 38.82 ± 3.32 kg/m2 . The mean amoxicillin area under the plasma concentration versus time curve from time zero to the time of the last quantifiable concentration ( AUC0–tlast ) increased significantly ( 3.5-fold ) ; the maximum plasma concentration ( Cmax ) increased 2.8-fold after the bariatric surgery . No correlation was found between amoxicillin absorption , BMI , and weight loss percentage . Conclusion The alterations observed in the amoxicillin pharmacokinetics suggest that obese subjects included in this trial had a substantially increase in amoxicillin systemic exposure after RYGB surgery . However , despite this increase , its exposure was lower than the values reported for non-obese volunteers . Trial Registration Identifiers : BACKGROUND Thromboembolic disease is a potentially serious complication in bariatric surgery patients . Direct oral anticoagulants ( DOAC ) have been investigated in orthopedic surgery patients .  DOAC data after bariatric surgery are still limited to the early postsurgical period . Whether postsurgical midterm adaptations due to anatomic and physiologic alterations influence drug pharmacology is currently not known . OBJECTIVE The aim of this study was to investigate the influence of weight loss and type of bariatric surgery on midterm postsurgical pharmacokinetic and pharmacodynamic parameters of rivaroxaban . SETTING University hospital . METHODS In this monocentric study , bariatric patients received a single oral dose of rivaroxaban ( 10 mg ) 6 to 8 months after sleeve gastrectomy ( SG ) or Roux-en-Y-gastric bypass ( RYGB ) . Pharmacokinetic and pharmacodynamic parameters were assessed and compared with prebariatric surgery results . RESULTS We included 6 RYGB and 6 SG patients .  Percent excess weight loss was 71.4 % ( interquartile range 56.4 , 87.9 ) in the SG group and 76.6 % ( 64.5 , 85.7 ) in the RYGB group . Rivaroxaban mean areas under the curve 6 to 8 months after the bariatric procedure ( 922.4 µg × h/L , coefficient of variation 43.2 ) were comparable to those measured preoperatively ( 952.6 µg × h/L , 16.8 ) . There was no relevant difference between the 2 surgical procedure groups . Rivaroxaban led to a decrease of prothrombin fragments F1 + 2 over 12 hours after oral intake confirming in vivo efficacy . CONCLUSIONS Significant weight loss and altered anatomy after RYGB and SG procedures do not appear to affect the pharmacokinetics and pharmacodynamics of prophylactic rivaroxaban . A single dose of Rivaroxaban was well tolerated and considered safe in this trial BACKGROUND Patients who undergo surgery are at risk of malnutrition due to periods of starvation , the stress of surgery , and subsequent increase in metabolic rate . There are limited data on nutritional outcome of surgical patients . AIMS To investigate changes in nutritional status and the influence of oral supplements on nutritional status , morbidity , and quality of life in postoperative surgical patients . METHODS Entry was determined by the presence of malnutrition , as defined by a body mass index ( BMI ) ⩽20 kg/m2 , anthropometric measurements ⩽15th percentile on admission , or initiation of oral diet postoperatively and /or a weight loss of 5 % or more during the operative period . We studied 101 patients : 52 were r and omised to the treatment group ( TG ) and prescribed a 1.5 kcal/ml nutritional supplement ; 49 patients were r and omised to the control group ( CG ) and continued with routine nutritional management .  Nutritional status was assessed by weight , anthropometry , and grip strength , with measurements taken at two weekly intervals for 10 weeks . Complications , namely wound infection , chest infection , and antibiotic use were documented . Quality of life ( QOL ) was assessed using the UK SF-36 question naire . RESULTS Patients in the control group lost a maximum mean ( SD ) of 5.96 ( 4.21 ) kg in weight over a period of eight weeks while patients in group TG lost less weight overall ( maximum mean ( SD ) 3.40 ( 0.89 ) kg ( p<0.001 ) occurring at four weeks and progressively regained weight from week 4 ) . Anthropometry , grip strength , and QOL were similarly significantly different between groups ( p<0.001 ) . Fewer patients in the treatment group ( 7/52 ) required antibiotic prescriptions compared with the control group ( 15/49 ) . CONCLUSIONS Nutritional status declined for two months after discharge . Postoperative nutritional supplementation improved nutritional status , QOL , and morbidity in these patients Objectives We design ed this study to assess intestinal absorption in patients with adequate or altered hemodynamic status after cardiac surgery and to test clinical tolerance to early enteral nutrition . Design Prospect i ve , descriptive study . Setting Surgical intensive unit in a university teaching hospital . Patients Cardiac surgery patients , age 64 ± 10 yrs ( mean ± sd ) were subdivided into two groups according to hemodynamic status : group I , 16 patients with adequate hemodynamic status ; group II , 23 patients with hemodynamic failure . These groups were compared with healthy controls ( group III , n = 6 ) . Interventions Paracetamol pharmacokinetic study on days 1 and 3 with nasogastric or postpyloric paracetamol administration . Early postpyloric or conventional gastric nutrition in group II . Measurements and Main Results Plasma concentrations were measured on days 1 and 3 , and area under the curve ( AUC ) was calculated . Absorption was strongly reduced on day 1 in all patients after gastric administration ( lower peak paracetamol and AUC ) , but normal after postpyloric delivery . Duration of anesthesia and of circulatory bypass did not affect paracetamol absorption . On day 3 , AUC was close to normal in case of hemodynamic failure . Peak absorption on day 1 was negatively correlated with opiate dose ( r2 = 0.176 , p = .008 ) . Hypocaloric enteral nutrition was well tolerated . Conclusions The close-to-normal AUC , during low cardiac output , despite lower peak paracetamol , shows absorption was not suppressed , only delayed , because of decreased pyloric motility . The decrease on day 1 can be attributed to opiates , known to alter pyloric function and to slow down the intestinal transit OBJECTIVE To evaluate recruitment manoeuvre ( RM ) efficiency associated with a 10 cmH(2)O positive end expiratory pressure ( PEEP ) on respiratory mechanic estimated by lung compliance ( Ctp ) and PEEP to ZEEP expiratory volume delta ( Delta VTE ) during laparoscopic bariatric surgery in patients with morbid obesity . STUDY DESIGN Prospect i ve r and omized study . METHODS Twenty-six obese patients ( BMI > 40 kg/m(2 ) ) undergoing laparoscopic bariatric surgery .  The recruitment group received an RM followed by a 10 cmH(2)O PEP versus only 10 cmH(2)O PEP in the control group . Ctp was measured during the intervention and functional residual capacity ( FRC ) was estimated measuring Delta VTE during a PEP to ZEP manoeuvre . Mann and Whitney tests as well as a t-test were used ( significance p<0.05 ) . RESULTS In the RM group , a significant improvement of 52+/-14 ml/cmH(2)O was noted versus a 36+/-10 ml/cmH(2)O in the PEP group ( p=0,004 ) . This improvement was transitory and no statistically significant Delta VTE difference was noted between the groups at the end of the intervention ( 360 [90 - 770]ml [ MRA ] and 310 [190 - 450]ml [ PEP ] ) . CONCLUSION In patients with morbid obesity undergoing laparoscopic bariatric surgery , an RM conducted prior the pneumoperitoneum temporarily improves lung mechanics but without any change of the end expiratory lung volume at the end of the surgery in comparison with PEP alone . The RM was well tolerated The aim of this study was to attempt to determine the minimum effective regimen of amoxicillin antibiotic prophylaxis for dental implant surgery . One hundred patients were r and omly allocated to 4 different antibiotic prophylactic treatment groups . At second-stage surgery , only 2 implants failed in the nonantibiotic group . No statistically significant differences were found in the 4 groups , probably because of the limited number of the sample s. Until a study with a larger population may definitely rule on the role of antibiotics in oral implant surgery , in may be prudent for the practitioner to adopt the single preoperative antibiotic dose as the minimal effective regimen ABSTRACT The objective of this study was to characterize the relationship between gentamicin concentrations during surgery and the development of wound infection following colorectal operations . Despite decades of research in surgical prophylaxis , the relationship between intraoperative antibiotic concentrations and postoperative infection and the concentrations required for effective prophylaxis have not been established . A pharmacodynamic analysis was conducted using data from a previous prospect i ve , r and omized , double-blind clinical study which compared two dosage regimens of gentamicin plus metronidazole for prophylaxis in connection with elective colorectal surgery . Univariate and multivariate analyses of risk factors for postoperative wound infection were conducted , and the relationship between intraoperative gentamicin concentrations and surgical outcome was characterized . The gentamicin concentration at the time of surgical closure was one of the strongest independent risk factors for infection ( P = 0.02 ) , along with the presence of diabetes mellitus ( P = 0.02 ) , stoma ( P = 0.04 ) , and advanced age ( P = 0.05 ) . Gentamicin concentrations at closure of less than 0.5 mg/liter were associated with an infection rate of 80 % ( representing 8 of 10 patients with concentrations below that level ) ( P = 0.003 ) . Receiver operating characteristic curve analysis identified a critical closure concentration of 1.6 mg/liter for effective surgical prophylaxis ( P = 0.002 ; sensitivity , 70.8 % ; specificity , 65.9 % ) . This study provides new and important information on antibiotic pharmacodynamics in surgical prophylaxis . It demonstrates the critical effect of the antibiotic concentration at closure on wound infection and suggests a significant association between the concentration and other well-established risk factors , like the timing of preoperative antibiotic administration and surgery duration PURPOSE The purpose of this prospect i ve study was to compare the efficacy of prophylactic antibiotic regimens commonly used in dental implant surgery . Preoperative single-dose and long-term prophylactic antibiotic regimens were compared . MATERIAL S AND METHODS This was a 2-center prospect i ve study in which 215 patients underwent ambulatory endosseous implant placement . In the first group , 445 dental implants were placed in 125 patients after the administration of a single preoperative dose of prophylactic antibiotic with no postoperative antibiotics . In the second group , 302 dental implants were placed in 90 patients who received a preoperative dose of antibiotics  and were instructed to take antibiotics postoperatively for 7 days . In both groups , 0.12 % chlorhexidine pre- and postoperative mouth rinses were used . Patients returned for postoperative evaluation at 1 week , 2 weeks , and just prior to surgical uncovering . The surgical sites were assessed for pain , swelling , erythema , and purulence . RESULTS In the first group , 3 patients developed wound dehiscence at 5 implant sites and 1 developed a minor inflammatory response . None of the patients in this group received further antibiotics . In the second group , 3 patients developed wound dehiscence , 2 developed an inflammatory response , and 1 was diagnosed with infection , for which another course of antibiotics was required . There was no statistical difference between the 2 groups according to the Fisher 2 x 4 exact test ( P = .56 ) . DISCUSSION Indiscriminate use of antibiotics is unacceptable in clinical practice today . Surgeons must adhere to basic principles to gain the most benefit from the use of prophylactic antibiotics . CONCLUSION Long-term prophylactic antibiotic  use in implant surgery was of no advantage or benefit over a single-dose preoperative antibiotic regimen in this patient population Background The purpose of this study was to determine the impact of bariatric surgery on employment status in underserved , unemployed patients with severe obesity . Methods A retrospective review of all unemployed severely obese patients seen in our urban safety-net bariatric surgery program was performed . Preoperative patient question naires and medical records were review ed to evaluate patient employment status at the time of initial evaluation by the multidisciplinary bariatric surgery team . Follow-up data was obtained on all available patients ( including those who did not undergo surgery ) , including weight and employment status . A st and ardized telephone question naire was administered to supplement details regarding employment . Changes in employment status and body weight were determined in both groups . Results Here , 193 unemployed severely obese patients were evaluated by the multidisciplinary obesity team . The vast majority of patients ( > 80 % ) were minorities ( primarily Hispanic ) and publicly insured . Seventy-two underwent bariatric surgery and 121 did not . Twenty-four percent of the surgical patients and 9 % of the non-surgical patients had acquired full-time employment at least one year postoperatively ( p = 0.043 ) . There was a 10-point body mass index reduction in the surgical group , compared to 1-point reduction in the non-surgical group after one year . Conclusions Bariatric surgery may improve employment status in an unemployed severely obese patient cohort . Future research in this area should collect detailed prospect i ve data on employment prior to surgery and assess changes longitudinally to provide a more complete picture of the impact of bariatric surgery on employment BACKGROUND Bariatric surgery is a powerful treatment of severe obesity . During the past several years , a greater appreciation for the need for multidisciplinary care to optimize outcomes has developed , and a number of studies have been started to examine the role of postoperative interventions used in combination with surgery . The purpose of the present study was to investigate the hypothesis that the provision of postoperative dietary counseling , delivered by a registered dietitian , would lead to greater weight loss and more positive improvements in dietary intake and eating behavior compared with st and ard postoperative care . The study was performed at an academic medical center . METHODS Eighty-four individuals who underwent bariatric surgery were r and omly assigned to receive either dietary counseling or st and ard postoperative care for the first 4 months after surgery . The participants completed measures of macronutrient intake and eating behavior at baseline and 2 , 4 , 6 , 12 , 18 , and 24 months after surgery . RESULTS The patients who received dietary counseling achieved greater weight loss than those who received st and ard postoperative care that did not involve this counseling , although this difference did not reach statistical significance . Patients in the dietary counseling arm did report significant changes in several eating behaviors believed to be important to successful long-term weight maintenance . CONCLUSION The results of our pilot study provide some support for the efficacy of early postoperative dietary counseling to improve outcomes after bariatric surgery Objective : The objective of this study was to evaluate the efficacy and safety of giving general anesthesia without the use of any opioids either systemic or intraperitoneal in bariatric surgery . Methods : Prospect i ve r and omized controlled trial . Obese patients ( body mass index > 50 Kg/m2 ) undergoing laparoscopic sleeve gastrectomies were recruited and provided an informed signed consent . Patients were r and omized using a computer generated r and omization table to receive either opioid or non-opioid based anesthesia . The patient and the investigator scoring patient outcome after surgery were blinded to the anesthetic protocol . Primary outcomes were hemodynamics in the form of “ heart rate , systolic , diastolic , and mean arterial blood pressure ” on induction and ½ hourly thereafter . Pain monitoring through visual analog scale ( VAS ) 30 min after recovery , hourly for 2 h and every 4 h for 24 h was also recorded . Pain monitoring through VAS and post-operative nausea and vomiting 30 min after recovery were also recorded and finally patient satisfaction and acute pain nurse satisfaction . Results : There was no difference in background characteristics in both groups . There were no statistically significant differences in different outcomes as heart rate , mean blood pressure , O2 saturation in different timings between groups at any of the determined eight time points but pain score and nurse satisfaction showed a trend to better performance with non-opioid treatment . Conclusion : Nonopioid based general anesthesia for Bariatric surgery is as effective as opioid one . There is no need to use opioids for such surgery especially that there was a trend to less pain in non-opioid anesthesia OBJECTIVE Enteral administration of synbiotics has been reported to be beneficial during various types of surgery , but its clinical value in elderly surgical patients remains unclear . The aim of this study was to quantitatively evaluate the changes in gut microbiota and environment induced by perioperative synbiotic therapy , and to investigate whether it is possible to reduce infectious complications in elderly patients undergoing gastroenterological surgery . METHODS Forty-eight patients over the age of 70 y were r and omized into a group receiving 7 d of preoperative and 10 d of postoperative synbiotic therapy ( S group ) and a control group without synbiotic therapy ( C group ) . A fecal sample collected before and after surgery in each group was used for a quantitative evaluation of the microbiota . RESULTS Forty-eight patients completed the trial ( 25 in the S group and 23 in the C group ) . Synbiotic therapy significantly maintained the status of Bifidobacterium and Lactobacillus , whereas the number of Enterobacteriaceae , Staphylococcus , and Pseudomonas was significantly decreased . The total organic acid and short-chain fatty acid concentrations were increased , and the pH was markedly decreased , in the S group compared with the C group . The incidence of postoperative infectious complications was 12 % in the S group and 36 % in the C group , however , the difference did not reach statistical significance ( P = 0.06 ) . A multivariate analysis revealed that only the use of perioperative blood transfusion was an independent risk factor for infectious complications . CONCLUSIONS Synbiotic therapy improved the intestinal microbial environment , and might decrease the incidence of infectious complications in elderly surgical patients Recently , the link between obesity and gut microbiota has become a focus for research . This study shed some light on the modification of postoperative gut microbial composition after  bariatric surgery .  A prospect i ve longitudinal study on healthy lean subjects and patients who underwent bariatric surgery ( Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy )  was carried out . Anthropometric and metabolic data , smoking , food preferences data , and stool sample s were collected from lean subjects and from obese patients before and 3 and 6 months after surgery ( T0 , T3 , and T6 , respectively ) . We collected stool sample s from 25 obese patients before surgery and 3 and 6 months thereafter and from 25 normal weight patients . After Roux-en-Y gastric bypass , Yokenella regensburgei ( p < 0.05 ) , Fusobacterium varium ( p < 0.05 ) , Veillonella dispar/atypica ( p < 0.05 ) , and Streptococcus australis/gordonii ( p < 0.05 ) were transiently identified in the gut at T3 . Roux-en-Y gastric bypass patients had a permanent increase in Akkermansia muciniphila ( p < 0.05 ) , which is associated with healthy metabolism , both at T3 and T6 . There were no significant changes in gut microbiota in laparoscopic sleeve gastrectomy patients . In our study , Roux-en-Y gastric bypass induced major microbial differences and greater weight loss compared with laparoscopic sleeve gastrectomy . Analyzing the microbiota composition , a proliferation of potential pathogens and the onset of beneficial bacteria was observed . The effects of these bacteria on human health are still far from clear . Underst and ing the mechanisms of action of these bacteria could be the keystone in developing new therapeutic strategies for obesity Background Bariatric surgery is known as one of the most effective treatments for sustainable weight loss ; however , it may be associated with some complications . This study was design ed to examine the effects of probiotic supplementation on some morbidities related to this surgery . Methods This was a placebo-controlled , double-blind , r and omized clinical trial on morbid obese patients referred for One Anastomosis Gastric Bypass- Mini Gastric Bypass ( OAGB-MGB ) surgery to a tertiary referral center . Patients were assigned to receive a probiotic supplement ( Familact ® ) or placebo from 4 weeks prior to surgery to 12 weeks after surgery . Anthropometric , biochemical , and inflammatory indices were evaluated at the beginning and the end of the study . Results At the end of study , significant improvements in some serum inflammatory markers , vitamin D status , and anthropometric measurements were observed ( p < 0.05 ) , which were significantly more in probiotic group rather than placebo group ( p < 0.05 ) . Moreover , significant improvements in glycemic indices and lipid profile were observed in both groups ; however , these changes were not significantly different between the groups . There was no significant difference in serum levels of vitamin B12 , folate , and homocysteine between groups at week 16 of the study . Discussion Our results indicate that probiotic supplementation promotes inflammatory markers , body weight loss , and status of vitamin D in patients undergoing OAGB-MGB bypass . Whether these findings will sustain in longer treatment duration remained to be eluci date d in future studies .Trial Registration This study has been registered at Clinical trial.gov with registration number NCT02708589 BACKGROUND Obesity is a risk factor for self-reported asthma and makes asthma management more difficult . The effects of bariatric surgery on asthma in severely obese subjects remain to be documented . METHODS In this prospect i ve study , 12 asthmatic patients with severe obesity were evaluated before , 6 and 12 months after bariatric surgery .  Each had methacholine inhalation tests , measures of expiratory flows and lung volumes , measurements of C-reactive protein and question naires on asthma medication , asthma symptoms and co-morbid conditions . Eleven severely obese patients with asthma ( considered as controls ) underwent the same evaluations . Primary endpoint was airway responsiveness to methacholine and secondary endpoints were lung volumes and markers of systemic inflammation . RESULTS Mean body mass index decreased from 51.2 to 34.4 kg/m(2 ) twelve months post-surgery . Mean PC(20 ) methacholine improved from 0.84 to 6.2 mg/ml ( P < 0.001 ) ; FEV(1 ) , FVC , FRC , FRC/TLC and ERV all improved ( P ≤ 0.006 ) . C-reactive protein decreased from 8.6 to 1.7 mg/L ( P < 0.001 ) Asthma symptoms total score was significantly reduced ( P = 0.03 ) and asthma medication needs decreased , ten patients being able to stop all asthma drugs . No significant changes of these parameters from baseline were observed in asthmatic controls . Improvements in airway responsiveness and lung volumes happened in parallel and correlated with reductions of body mass index ( r = 0.58 , P = 0.049 ) , C-reactive protein levels ( r = -0.74 , P = 0.004 ) . CONCLUSION Airway responsiveness , lung volumes and asthma severity/control markedly improved with weight loss following bariatric surgery in severely obese patients BACKGROUND High rates of inappropriate use of prophylactic antibiotics in surgery continue to be reported in the literature , with many institutions design ing interventions aim ed at improving prescription . This study evaluates the surgical arm of a clinician-focused educational antimicrobial stewardship program implemented in February 2014 at Blacktown Hospital , Australia . METHODS A before-after analysis of the surgical antibiotic prophylaxis intervention  was conducted at Blacktown Hospital , New South Wales , Australia . Two hundred abdominal general surgical patients were selected via simple r and om sampling and categorized into pre-intervention ( n = 100 ) and post-intervention ( n = 100 ) groups . Antibiotic prophylaxis regimens were compared with the Australian guideline , Therapeutic Guidelines : Antibiotic ( v14 ) with respect to drug choice , dosage , timing of administration , and duration of administration . RESULTS Overall adherence rates in the pre- and post-intervention periods were 18 % and 15 % respectively , demonstrating no substantial change ( p = 0.568 ) . No patients in either group were administered antibiotics without an appropriate indication . There were no substantial decreases in error rates across any category , including drug choice , dosage , timing of administration , duration of administration , or re-dosing . The apparent decrease in the rate of inappropriate broad-spectrum cephalosporin usage was not statistically significant ( 29.3 % vs. 18.8 % ; p = 0.16 ) . CONCLUSIONS The educational intervention studied demonstrated no substantial change to overall adherence . Given the frequent failure of such interventions , stronger and more directly m and ated adoption of prescribing guidelines is recommended for surgical services . Future consideration should be given to focused computer-based solutions , integrated with electronic medical records where possible BACKGROUND / AIMS The aim of this study was to evaluate the effect of antibiotic prophylaxis on the development of infectious complications in laparoscopic cholecystectomy . METHODOLOGY A total of 208 patients undergoing elective laparoscopic cholecystectomy were r and omized , double-blinded into one of two treatment arms : 1 ) cefazolin 1 g intravenously after induction of anesthesia and 2 ) no prophylactic antibiotics . The patients were followed-up for infectious complications for 30 days at the out-patient clinic . The data collected included age , sex , body mass index , ultrasonography findings , accompanying diseases , perforation during surgery , stone spillage , operation time , port of gallbladder delivery , suture material used for skin closure , preoperative and length of postoperative hospitalization , bile culture , pathology of the gallbladder , serum biochemical findings including alanine aminotransferase , aspartate aminotransferase , gammaglutamyl transpeptidase , bilirubin , alkaline phosphatase and glucose . RESULTS Overall rate of infection was 3.36 % . Four out of 105 patients who received antibiotics and 3 out of 103 patients who did not receive antibiotics developed infection . The difference was not statistically significant . Obesity and closing the skin with nylon sutures were found to be associated with increased rate of infectious complications . CONCLUSIONS Cefazolin prophylaxis in low risk patients has no effect on postoperative infection rate in laparoscopic cholecystectomy
Patients given oral beta-lactams and macrolides warrant close monitoring due to unpredictable absorption post-bariatric surgery , whereas oral fluoroquinolones and linezolid may not be affected .
Several studies also showed decreased absorption following RYGB , as well as lower serum exposure in patients with obesity compared to non-obese controls .
The purpose of this study was to conduct a systematic review of the existing literature to determine the effect of bariatric surgery on various pharmacokinetic parameters of oral antibiotic absorption as well as overall patient outcomes .