Chemical Bowel Preparation Exerts an Independent Preventive Effect Against Surgical Site Infection Following Elective Laparoscopic Colorectal Surgery

Abstract

Purpose: We investigated the clinical value of mechanical and chemical bowel preparations (MBP, CBP) for preventing surgical site infection (SSI) in patients undergoing elective laparoscopic colorectal surgery. Methods: This retrospective cohort study included 475 patients who underwent elective laparoscopic colorectal surgery between January 2018 and March 2022. CBP was introduced in January 2021. CBP included kanamycin (1 g) and metronidazole (1 g) two times a day, the day before surgery. In some cases, MBP was omitted in patients who planned to undergo right-sided colectomy, those with tumor obstruction, and those with poor general condition, depending on the physician’s judgment. The endpoints were primarily the overall incidence of SSI, and secondarily incisional SSI, organ-space SSI, culture from the surgical site, and postoperative hospital stay. Results: In total, 136 patients underwent CBP. MBP was omitted in 53 patients. Overall, SSI occurred in 80 patients (16.8%), including 61 cases of incisional SSI (12.8%) and 36 cases of organ-space SSI (7.6%). Multivariate logistic regression revealed that CBP exerted an independent preventive effect on overall and incisional SSI, whereas MBP did not. Levels of Bacteroides species at the surgical site were significantly lower in the CBP group than in the non-CBP group. Postoperative hospital stay was significantly longer in the incisional SSI group than in non-SSI group and was significantly longer in the organ-space SSI group than in the other groups.Conclusion: CBP, but not MBP, exerts an independent preventive effect on SSI, especially incisional SSI, in patients undergoing elective laparoscopic colorectal surgery.

A meta‐analysis of the risk factors for surgical site infection in patients with colorectal cancer

“…23 tests that were published between 2001 and 2023 were included in the meta‐analysis after an evaluation of 2309 applicable studies since they fit the inclusion criteria 23–45 . Table 2 summarizes the findings of these investigations.…”

“…For the current meta‐analysis, 23 examinations from 2001 to 2023 were included; of these, 89 859 individuals with CCs were included in the beginning point of the used investigations, and 7548 of them had SSI. The sample size was 60–67 613 people 23–45 . Clean‐contaminated surgical site wounds had a significantly lower infection compared to contaminated surgical site wounds in patients with CCs.…”

A meta‐analysis examined the effect of stoma on surgical site wound infection in colorectal cancer

“…Five papers between 2007 and 2022 that matched the inclusion criteria and were included in the meta‐analysis were chosen from a total of 3245 relevant studies that were evaluated. 17 , 18 , 19 , 20 , 21 …”

“…Five papers between 2007 and 2022 that matched the inclusion criteria and were included in the meta-analysis were chosen from a total of 3245 relevant studies that were evaluated. [17][18][19][20][21] The stoma present had significantly higher surgical site wound infections (OR, 4.37; 95% CI, 3.08-6.21; P < 0.001) with no heterogeneity (I2 = 12%) compared to stoma absent in colorectal cancer as shown in The visual inspection of the funnel plot and quantitative measurements made with the Egger regression test also revealed no evidence of publication bias (P = 0.90), but the majority of the included randomised controlled trials did not incorporate individual variables like age, gender, and ethnicity into stratified models to examine their influence on the comparison results.…”

“…At the start of the investigations, 3223 participants had colorectal cancer; 258 of them had a stoma, while 2965 did not have a stoma. [17][18][19][20][21] The stoma present had significantly higher surgical site wound infections compared to the stoma absent in colorectal cancer. The low number of selected studies in the meta-analysis calls for care when analysing the results.…”