Upper gastrointestinal surgery and the appendix.

In healthy humans the stomach, duodenum and proximal small bowel are almost sterile. Under pathological conditions, however, bacterial overgrowth occurs. The need for and duration of postoperative antibiotic treatment is based on the time from perforation to operation, and the degree of contamination or infection. Our recommendation ranges from no antibiotic in early cases with minimal contamination to 5 days of treatment when established peritonitis is encountered. The duration of treatment following appendectomy for acute appendicitis depends on the intraoperative findings: simple appendicitis: no postoperative antibiotics; phlegmonous or gangrenous appendicitis: 3 day course; perforated appendicitis with peritonitis or abscess formation: 3- to 5-day therapy.