A 40-year-old woman undergoes elective open cholecystectomy for symptomatic gallstones. The biliary tract is opened under controlled conditions and there is no spillage of bile. How is this operative wound classified?

• A Clean-contaminated wound (Class II) ✓
• B Clean wound (Class I)
• C Contaminated wound (Class III)
• D Dirty-infected wound (Class IV)

Explanation

Entry into the gastrointestinal, biliary or genitourinary tract under controlled conditions without unusual contamination defines a Class II clean-contaminated wound; infection risk is around 5 to 10%. B Class I clean wound carries no entry into such tracts, as in hernia repair. Class III involves fresh open accidental wounds or major breaks in technique, and Class IV involves established infection or perforated viscera.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

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