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In a prospective, randomized double-blind study either 400 mg of doxycycline + 1500 mg of metronidazole (D + M) or 400 mg of doxycycline (D) alone were given intravenously as a single preoperative dose to patients admitted for elective colorectal surgery. A comparison of the rate of postoperative septic complications was made. After excluding drop-out patients, 261 patients remained for evaluation. In 135 patients with D + M treatment there were four postoperative septic complications (3.0%). In 126 patients with D treatment 20 septic complications related to the surgical procedure occurred (15.9%). The difference is highly significant (p less than 0.005). Most postoperative infections were superficial wound infections (14 of 24 patients), and the mean hospital stay in the two treatment groups was equal. Bacteriologic studies showed a highly significant reduction in anaerobes in cultures from perioperative intra-abdominal fluid in the D + M treatment group. The study has thus showed that the addition of metronidazole, an efficient agent against anaerobic bacteria, to an antimicrobial agent against aerobic bacteria significantly reduces postoperative septic complications in elective colorectal surgery.

In 29 patients with gallstone pancreatitis, endoscopic papillotomy was performed during the first period (1976-1979) as elective procedure 1-8 weeks after the clinical symptoms had subsided. From 1979, endoscopic investigations and treatment were routinely done within 48 hours after the onset of clinical symptoms. The ERCPs and EPTs were well-tolerated and were performed without serious complications. The results of these series indicate that EPT can be safely performed in the acute stage of gallstone pancreatitis. Acute EPT gives effective drainage and relief of the acute symptoms in patients with obstructive pancreatitis.