Colorectal surgery and preoperative bowel preparation: aren't we drawing hasty conclusions?

Beyer-Berjot, Laura; Slim, Karem

doi:10.1111/codi.14415

Cited by 8 publications

(6 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These between-study differences are likely to be because of several biases in these retrospective series, as emphasised by Beyer-Berjot and Slim. 35 Patients who did not undergo preoperative MOABP in these retrospective trials had more comorbidities 10,13,31 and a more advanced stage of colorec tal cancer than those who had NBP. 10,11,31 Patients were classified according to the type of preparation they were intended to receive, not what they actually received.…”

Section: Resultsmentioning

confidence: 97%

Mechanical and oral antibiotic bowel preparation versus no bowel preparation for elective colectomy (MOBILE): a multicentre, randomised, parallel, single-blinded trial

et al. 2019

View full text Add to dashboard Cite

Background Decreased surgical site infections (SSIs) and morbidity have been reported with mechanical and oral antibiotic bowel preparation (MOABP) compared with no bowel preparation (NBP) in colonic surgery. Several societies have recommended routine use of MOABP in patients undergoing colon resection on the basis of these data. Our aim was to investigate this recommendation in a prospective randomised context. Methods In this multicentre, parallel, single-blinded trial, patients undergoing colon resection were randomly assigned (1:1) to either MOABP or NBP in four hospitals in Finland, using a web-based randomisation technique. Randomly varying block sizes (four, six, and eight) were used for randomisation, and stratification was done according to centre. The recruiters, treating physicians, operating surgeons, data collectors, and analysts were masked to the allocated treatment. Key exclusion criteria were need for emergency surgery; bowel obstruction; colonoscopy planned during surgery; allergy to polyethylene glycol, neomycin, or metronidazole; and age younger than 18 years or older than 95 years. Study nurses opened numbered opaque envelopes containing the patient allocated group, and instructed the patients according to the allocation group to either prepare the bowel, or not prepare the bowel. Patients allocated to MOABP prepared their bowel by drinking 2 L of polyethylene glycol and 1 L of clear fluid before 6 pm on the day before surgery and took 2 g of neomycin orally at 7 pm and 2 g of metronidazole orally at 11 pm the day before surgery. The primary outcome was SSI within 30 days after surgery, analysed in the modified intention-to-treat population (all patients who were randomly allocated to and underwent elective colon resection with an anastomosis) along with safety analyses. The trial is registered with ClinicalTrials.gov, NCT02652637, and EudraCT, 2015-004559-38, and is closed to new participants.

show abstract

Section: Resultsmentioning

confidence: 97%

Mechanical and oral antibiotic bowel preparation versus no bowel preparation for elective colectomy (MOBILE): a multicentre, randomised, parallel, single-blinded trial

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Therefore, a large RCT is needed to determine whether oral antibiotics alone and intravenous antibiotics are sufficient in reducing AL after colorectal surgery or whether association with mechanical bowel preparation is needed[26]. Furthermore, the type of MBP is very different among surgeon practice[27] and probably needs standardization before conclusion could be drawn from MBP studies.…”

Section: Preoperative Measures To Prevent Almentioning

confidence: 99%

Reducing anastomotic leak in colorectal surgery: The old dogmas and the new challenges

Meyer¹,

Naiken²,

Christou³

et al. 2019

WJG

View full text Add to dashboard Cite

Anastomotic leak (AL) constitutes a significant issue in colorectal surgery, and its incidence has remained stable over the last years. The use of intra-abdominal drain or the use of mechanical bowel preparation alone have been proven to be useless in preventing AL and should be abandoned. The role or oral antibiotics preparation regimens should be clarified and compared to other routes of administration, such as the intravenous route or enema. In parallel, preoperative antibiotherapy should aim at targeting collagenase-inducing pathogens, as identified by the microbiome analysis. AL can be further reduced by fluorescence angiography, which leads to significant intraoperative changes in surgical strategies. Implementation of fluorescence angiography should be encouraged. Progress made in AL comprehension and prevention might probably allow reducing the rate of diverting stoma and conduct to a revision of its indications.

show abstract

“…La preparación intestinal se realizó en menos de la mitad de los pacientes sometidos a cirugía colorrectal, y el tipo de anastomosis utilizada fue únicamente mecánica. Existen controversias entre los protocolos de preparación mecánica del colon reportados desde el año 2000, ya que emiten diferentes opiniones sobre la implementación o no de esta, siendo más predominante su contraindicación; sin embargo, dichas aseveraciones se han ido refutando con nuevas evidencias que, aunque se postulan con un nivel de evidencia bajo-moderado, hablan de los beneficios otorgados al paciente con la preparación mecánica del colon y la administración de antibióticos orales en cirugía colorrectal, sobre todo en la prevención de la infección del sitio quirúrgico, y la incidencia baja en prevención de fugas anastomóticas 17 .…”

Section: Discussionunclassified

Factores asociados a dehiscencia de anastomosis intestinal

Álvarez-Villaseñor¹,

Prado-Rico²,

Morales-Alvarado³

et al. 2021

CIRU

View full text Add to dashboard Cite

show abstract

Colorectal surgery and preoperative bowel preparation: aren't we drawing hasty conclusions?

Cited by 8 publications

References 22 publications

Mechanical and oral antibiotic bowel preparation versus no bowel preparation for elective colectomy (MOBILE): a multicentre, randomised, parallel, single-blinded trial

Mechanical and oral antibiotic bowel preparation versus no bowel preparation for elective colectomy (MOBILE): a multicentre, randomised, parallel, single-blinded trial

Reducing anastomotic leak in colorectal surgery: The old dogmas and the new challenges

Factores asociados a dehiscencia de anastomosis intestinal

Contact Info

Product

Resources

About