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.