Bowel preparation: Comparing metabolic and electrolyte changes when using sodium phosphate/polyethylene glycol

Shapira, Z; Feldman, Leonid; Lavy, Ron; Weissgarten, Joshua; Haitov, Zoya; Halevy, Ariel

doi:10.1016/j.ijsu.2010.04.009

Cited by 23 publications

(14 citation statements)

References 14 publications

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“…The role of mechanical bowel preparation (MBP) before surgery is an area of contention, with opinions varying on either side of the Atlantic. The disadvantages of MBP are the unwanted complications, including hypovolaemia, metabolic disturbance, and poor patient compliance . The advantages include the ability to perform intra‐operative endoscopy and to avoid a faecally loaded colon.…”

Section: The Role Of Mechanical Bowel Preparationmentioning

confidence: 99%

A collaborative review of the current concepts and challenges of anastomotic leaks in colorectal surgery

et al. 2017

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The reduction of the incidence, detection and treatment of anastomotic leakage (AL) continues to challenge the colorectal surgical community. AL is not consistently defined and reported in clinical studies, its occurrence is variably reported and its impact on longterm morbidity and health-care resources has received relatively little attention. Controversy continues regarding the best strategies to reduce the risk. Diagnostic tests lack sensitivity and specificity, resulting in delayed diagnosis and increased morbidity. Intra-operative fluorescence angiography has recently been introduced as a means of real-time assessment of anastomotic perfusion and preliminary evidence suggests that it may reduce the rate of AL. In addition, concepts are emerging about the role of the rectal mucosal microbiome in AL and the possible role of new prophylactic therapies. In January 2016 a meeting of expert colorectal surgeons and pathologists was held in London, UK, to identify the ongoing controversies surrounding AL in colorectal surgery. The outcome of the meeting is presented in the form of research challenges that need to be addressed.

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Section: The Role Of Mechanical Bowel Preparationmentioning

confidence: 99%

A collaborative review of the current concepts and challenges of anastomotic leaks in colorectal surgery

et al. 2017

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“… 6 Although several studies provided evidence for the role of oral antibiotics in elective colorectal surgery, the regimens included large volume preparations, 8 – 10 prolonged preoperative hospital admission, and in the setting of prolonged preoperative starvation protocols, dehydration, and electrolyte disturbances were commonplace. 11 , 12 Decreased compliance and inconsistent bowel cleansing resulted in a reduced intervention effect and, this, combined with reduced preoperative admission times, resulted in the practice of combined MBP+OAB dwindling in favor of more restrictive MBP regimens alone. However, recently there has been resurgent interest in the use of OAB in colorectal surgery, 13 , 14 particularly in light of a large number of retrospective cohort and database studies, many of which originated from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) targeted colectomy database.…”

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confidence: 99%

The Role of Oral Antibiotic Preparation in Elective Colorectal Surgery

et al. 2019

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Objectives To compare the impact of the use of oral antibiotics (OAB) with or without mechanical bowel preparation (MBP) on outcome in elective colorectal surgery. Summary Background Data Meta-analyses have demonstrated that MBP does not impact upon postoperative morbidity or mortality, and as such it should not be prescribed routinely. However, recent evidence from large retrospective cohort and database studies has suggested that there may be a role for combined OAB and MBP, or OAB alone in the prevention of surgical site infection (SSI). Methods A meta-analysis of randomized controlled trials and cohort studies including adult patients undergoing elective colorectal surgery, receiving OAB with or without MBP was performed. The outcome measures examined were SSI, anastomotic leak, 30-day mortality, overall morbidity, development of ileus, reoperation and Clostridium difficile infection. Results A total of 40 studies with 69,517 patients (28 randomized controlled trials, n = 6437 and 12 cohort studies, n = 63,080) were included. The combination of MBP+OAB versus MBP alone was associated with a significant reduction in SSI [risk ratio (RR) 0.51, 95% confidence interval (CI) 0.46–0.56, P < 0.00001, I 2 = 13%], anastomotic leak (RR 0.62, 95% CI 0.55–0.70, P < 0.00001, I 2 = 0%), 30-day mortality (RR 0.58, 95% CI 0.44–0.76, P < 0.0001, I 2 = 0%), overall morbidity (RR 0.67, 95% CI 0.63–0.71, P < 0.00001, I 2 = 0%), and development of ileus (RR 0.72, 95% CI 0.52–0.98, P = 0.04, I 2 = 36%), with no difference in Clostridium difficile infection rates. When a combination of MBP+OAB was compared with OAB alone, no significant difference was seen in SSI or anastomotic leak rates, but there was a significant reduction in 30-day mortality, and incidence of postoperative ileus with the combination. There is minimal literature available on the comparison between combined MBP+OAB versus no preparation, OAB alone versus no preparation, and OAB versus MBP. Conclusions Current evidence suggests a potentially significant role for OAB preparation, either in combination with MBP or alone, in the prevention of postoperative complications in elective colorectal surgery. Further high-quality evidence is required to differentiate between the benefits of combined MBP+OAB or OAB alone.

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“…This is in part due to research showing that MBP alone does not confer protection against postoperative sepsis [6][7][8][9] and may be harmful. [10][11][12] As a result, many have recommended that it be completely abandoned. 6,9,13 Recently, there has been renewed interest in the effects of MBP with oral antibiotics.…”

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confidence: 99%

Combined Preoperative Mechanical Bowel Preparation With Oral Antibiotics Significantly Reduces Surgical Site Infection, Anastomotic Leak, and Ileus After Colorectal Surgery

et al. 2015

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Bowel preparation: Comparing metabolic and electrolyte changes when using sodium phosphate/polyethylene glycol

Abstract: On the basis of this study, we propose that the wide use of phosphate-containing drugs for colonic preparation might be dangerous for the specific group of patients that is prone to develop renal failure or electrolyte abnormalities.

Cited by 23 publications

References 14 publications

A collaborative review of the current concepts and challenges of anastomotic leaks in colorectal surgery

A collaborative review of the current concepts and challenges of anastomotic leaks in colorectal surgery

The Role of Oral Antibiotic Preparation in Elective Colorectal Surgery

Combined Preoperative Mechanical Bowel Preparation With Oral Antibiotics Significantly Reduces Surgical Site Infection, Anastomotic Leak, and Ileus After Colorectal Surgery

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