Is mechanical bowel preparation mandatory for left-sided colonic anastomosis? Results of a prospective randomized trial

Zmora, Oded; Mahajna, Ahmad; Bar-Zakai, Barak; Hershko, Dan; Shabtai, Moshe; Krausz, Michael M.; Ayalon, Amram

doi:10.1007/s10151-006-0266-1

Cited by 83 publications

(70 citation statements)

References 16 publications

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“…There have been numerous studies focused on the risks of bowel preparation and their appropriateness and numerous studies have found no evidence that mechanical bowel preparation has an effect on anastomotic leak. [100][101][102] Bearing this in mind, recommendations have been made to avoid mechanical bowel prepping patients due to concerns regarding patient satisfaction, potential electrolyte disturbances, and potential risk of Clostridium difficile infection.…”

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confidence: 99%

Reducing gastrointestinal anastomotic leak rates: review of challenges and solutions

Phillips¹

2016

OAS

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Various techniques and interventions have been developed in an effort to obviate gastrointestinal anastomotic leaks. This review is intended to delineate potential modifications that can be made to reduce the risk of anastomotic leaks following gastrointestinal surgery. It may also serve to aid in identifying patients who are at increased risk of anastomotic leak. Modifiable risk factors for leak discussed include malnutrition, smoking, steroid use, bowel preparation, chemotherapy, duration of surgery, use of pressors, intravenous fluid administration, blood transfusion, and surgical anastomotic technique. Based upon literature review, operative techniques should include minimizing operative time, reducing ischemia, and utilizing stapled anastomoses. Buttressing of anastomoses with omentum has proven utility for esophageal surgery. Further recommendations include 5-7 days of immune-modifying nutritional supplementation for malnourished patients, discontinuation of smoking in the perioperative period, limiting steroid use, utilization of oral antibiotic preparation for colorectal surgery, avoidance of early operations (,4 weeks) following chemotherapy, limiting pressor use, and the utilization of goal-directed fluid management.

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confidence: 99%

Reducing gastrointestinal anastomotic leak rates: review of challenges and solutions

Phillips¹

2016

OAS

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“…Although the bowel preparation facilitate the achievement of the surgical technique, making the operation less inconvenient, many other factors put this conduct in question, since there is evidence to prove the bacterial translocation to mesenteric lymph nodes when done the preparation 7,16 , higher peritoneal contamination during surgery due to liquid stool, 8, and gastrointestinal discomfort, involving 7,14 diarrhea, bloating and nausea. There are also systemic consequences, such as hydroelectrolytic disturbances of cardiac risk in cardiac patients 5 .…”

Section: Introductionmentioning

confidence: 99%

“…In 2005, Zmora et al 16 evaluated the results of a prospective randomized trial questioning the mechanical bowel preparation for anastomosis of the left colon; 249 patients were analyzed, 120 with preparation and 129 not, with higher rates of anastomotic leak and 4,2%x2,3% and 1,6%x0,7% respectively, favoring the non-preparation.…”

Section: Introductionmentioning

confidence: 99%

“…The infection significantly increases morbidity and mortality of surgery, and bacteria of the intestinal flora is main responsible 8,16 . The clinical presentation varies from wound infection, anastomotic fistula, abdominal abscess and generalized peritonitis.…”

Section: Introductionmentioning

confidence: 99%

“…The bowel preparation for elective colorectal operation has been performed worldwide as a routine uncontested for over 100 years for the prophylaxis of post-operative complications related to fecal contamination 5,7,10,14,16 . The infection significantly increases morbidity and mortality of surgery, and bacteria of the intestinal flora is main responsible 8,16 .…”

Section: Introductionmentioning

confidence: 99%

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Preparo mecânico dos cólons é uma rotina necessária?

Lins-Neto

Leão

Alves

et al. 2012

ABCD, arq. bras. cir. dig.

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HEADINGS -Colorectal surgery. Colon. Surgical wound infection. RESUMO -Racional -O valor do preparo de cólon prévio nas operações colorretaiscontinua discutível, visto que devido à tradição da rotina do preparo poucos estudos têm sido realizados para sustentação da operação segura sem o preparo mecânico. ABCDDV/831ABSTRACT -Background -The value of the preparation of the colon prior colorectal surgery remains debatable. Since installed as traditional the use of this routine, few studies have been conducted to support the safety of surgeries done without mechanical bowel preparation. Aim -To determine if there is a correlation between postoperative complications and no use of mechanical bowel preparation in operated patients. Methods -Was conducted a prospective study in patients undergoing coloproctology abdominal surgery without prior bowel preparation. Results -The sample consisted of 126 patients, 57 men and 69 women. The average age was 54 years (19 to 89). Among patients who had comorbidities (43 patients -34,12%), 30 (23,80%) had arterial hypertension. Antibiotic prophylaxis was used in 89,70%. Among the patients, 14,28% had complications: eight (6,34%) wound infection, six (4,76%) anastomotic dehiscence and four (3,17%) fistula. Conclusion -The pre-operative mechanical bowel preparation is not essential in the routine of colorectal surgeries.

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Association of Mechanical Bowel Preparation and Oral Antibiotics Before Elective Colorectal Surgery With Surgical Site Infection

et al. 2018

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Key Points Question Which approach is best to reduce surgical site infections and anastomotic leak in colorectal surgery: mechanical bowel preparation with oral antibiotics, oral antibiotics only, mechanical bowel preparation only, or no preparation? Findings Among 38 randomized clinical trials (8458 patients) in this network meta-analysis, mechanical bowel preparation with oral antibiotics was associated with the lowest rate of surgical site infections, reducing both incisional and organ/space infections. There was no significant difference in anastomotic leak rate between the 4 approaches. Meaning Mechanical bowel preparation with oral antibiotics is the best approach to reduce surgical site infections in patients undergoing colorectal surgery.

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Is mechanical bowel preparation mandatory for left-sided colonic anastomosis? Results of a prospective randomized trial

Abstract: These results suggest that elective left-sided anastomosis may be safely performed without mechanical preparation. Multicenter studies to test the reproducibility of these results are required, to support a change in this time-honored practice.

Cited by 83 publications

References 16 publications

Reducing gastrointestinal anastomotic leak rates: review of challenges and solutions

Reducing gastrointestinal anastomotic leak rates: review of challenges and solutions

Preparo mecânico dos cólons é uma rotina necessária?

Association of Mechanical Bowel Preparation and Oral Antibiotics Before Elective Colorectal Surgery With Surgical Site Infection

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