Mechanical bowel preparation combined with oral antibiotics reduces infectious complications and anastomotic leak in elective colorectal surgery: a pooled-analysis with trial sequential analysis

Yue, Yumin; Chen, Xi; Wang, Hui; Cheng, Min; Zheng, Bin

doi:10.1007/s00384-022-04302-8

Cited by 3 publications

(2 citation statements)

References 58 publications

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“…As a result, the incidence of AL was significantly lower in the group treated with MBP plus OAB compared with MBP alone (OR= 0.43, 95% CI= 0.23-0.81, p= 0.009, I2= 73%). In addition, SSI was significantly lower in the MBP plus oral antibiotics group (OR= 0.38, 95% CI= 0.32-0.46, p< 0.0001, I2= 24%) (36). The reference category is: Right colon.…”

Section: Discussionmentioning

confidence: 90%

Does mechanical bowel preparation really prevent complications after colorectal surgery depending on the lesion localization? A myth or fact?

Benli,

Tikici,

Baysan

et al. 2023

Turk J Surg

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Objective: Despite being routinely used before elective colorectal surgery in most surgical clinics, mechanical bowel preparation (MBP) remains controversial. This study aimed to investigate postoperative complications and outcomes of right, left, or rectosigmoid resection without MBP. Material and Methods: Patients who underwent elective colorectal surgery without mechanical bowel preparation and oral antibiotics between January 2011 and December 2021 were included in the study. Patients were categorized according to the side of resection, and these subgroups were compared for anastomotic leakage, surgical site infections (SSI), and overall morbidity measured using the Clavien-Dindo complication grade. Results: Data of 422 patients were analyzed. Overall anastomotic leakage was found in 14 patients (3.3%), SSI in 46 (10.9%), collection in 14 (3.3%), mortality in 18 (4.3%), and reoperation in 17 (%4) patients. Anastomotic leakage was observed in six (3.9%) in right colectomy, two (1.9%) in left colectomy, and in six (3.7%) patients in the rectosigmoid resection group when the groups were evaluated separately. There was no statistical difference between the groups (p= 0.630). Furthermore, there was no statistical difference between the groups regarding collection and reoperation (p values were p= 0.31, and p= 0.251, respectively). Conclusion: Study results showed that anastomotic leakage, surgical site infection, intra-abdominal collection, reoperation, and mortality rates were similar to the current literature obtained from the studies with mechanical bowel preparation. In addition, these results were found to be similar according to the resection site.

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Section: Discussionmentioning

confidence: 90%

Does mechanical bowel preparation really prevent complications after colorectal surgery depending on the lesion localization? A myth or fact?

Benli,

Tikici,

Baysan

et al. 2023

Turk J Surg

View full text Add to dashboard Cite

show abstract

“…A new concept of microbiome has been introduced whereby anastomotic contamination by digestive flora may result in anastomotic leak ( 8 ). In the last decade, studies show that the use of oral antibiotics preoperatively reduces the rate of anastomotic leak ( 9 ). A recent meta-analysis by Woodfield et al with 35 randomised controlled trials (RCTs) comparing intravenous (IV) antibiotics with or without enema, IV antibiotic with oral antibiotics, mechanical bowel preparation, mechanical bowel preparation with IV and oral antibiotics, mechanical bowel preparation with oral antibiotics and oral antibiotics alone showed no difference in anastomotic leak rate among these groups ( 10 ).…”

Section: Discussionmentioning

confidence: 99%

Surgical considerations for the “perfect” colorectal anastomosis

Ong,

Tan,

Teo

et al. 2023

J Gastrointest Oncol

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A technically sound colorectal anastomosis is paramount in optimising outcomes and reducing complications such as anastomotic leak which can lead to prolonged hospital stay, repeated operations, stoma formation, anastomotic stricture formation and even mortality in patients. Therefore, thorough consideration should be given to all aspects of its construct, from its basic mechanical configuration to subsequent evaluation of anastomosis integrity and perfusion. Risk factors for anastomotic leakage are well established and are usually classified into modifiable and non-modifiable risk factors. In this review article, we will focus on and discuss the modifiable surgical risk factors and how the authors incorporate latest evidence and surgical principles in creating a “perfect” colorectal anastomosis. We review the latest evidence on the proper mechanical construct of a colorectal anastomosis, enhanced recovery after surgery (ERAS), high versus low ligation of inferior mesenteric artery (IMA), routine splenic flexure mobilisation (SFM), the use of indocyanine green (ICG), as well as methods used for the evaluation of the anastomosis integrity. New adjuncts described in the literature to reinforce anastomoses are also discussed. In summary, meticulous technique with nuanced refinements based on our understanding of surgical principles, together with the adoption of relevant new technologies, are essential in our strive towards the “perfect” colorectal anastomosis.

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Modified oral antibiotics and mechanical bowel preparation (OAMBP) versus conventional OAMBP for sigmoid colon and rectal surgery: A multicenter randomized non‐inferiority trial

Arai,

Hanaoka,

Yamauchi

et al. 2024

Annals of Gastroent Surgery

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AimTo evaluate whether the use of a laxative with reduced patient burden in oral antibiotics and mechanical bowel preparation (OAMBP) could prevent surgical site infection (SSI) in left‐sided colon and rectal cancers.MethodsThis multicenter, non‐blinded, randomized, non‐inferiority trial included patients who underwent elective colorectal surgery for colorectal cancer in a university and community hospital in Japan from April 1, 2021 to March 31, 2023. We compared conventional OAMBP (polyethylene glycol, metronidazole, and kanamycin) (cOAMBP group) with modified OAMBP (sodium picosulfate hydrate, metronidazole, and kanamycin) (mOAMBP group). The primary outcome was overall incidence of SSI. Secondary outcomes were postoperative complications, degree of patient burden, and intraoperative bowel dilatation.ResultsAmong 119 patients, 112 were randomly assigned to the two groups, with 56 patients in each group. SSI occurred in three (5.4%) and five patients (8.3%) in the mOAMBP and cOAMBP groups, respectively (90% confidence interval [CI]: −12.8–5.3), with a 15% margin of non‐inferiority. Anastomotic leakage occurred in no patient in the mOAMBP group and three patients (5.4%) in the cOAMBP group (p = 0.24). The cOAMBP group reported significantly more pain than the mOAMBP group (50 [90.9%] vs. 7 [12.5%] participants). The mOAMBP group showed significantly lesser bowel dilatation than the cOAMBP group (1 [1.8%] vs. 21 [37.5%] participants).ConclusionmOAMBP is safe and less burdensome, can reduce intraoperative bowel dilatation, and is non‐inferior compared with cOAMBP in preventing SSI. Therefore, mOAMBP may be more suitable for sigmoid colon and rectal cancer.Trial RegistrationUMIN000043162 (http://www.umin.ac.jp/ctr/). Registered on January 28, 2021.

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Mechanical bowel preparation combined with oral antibiotics reduces infectious complications and anastomotic leak in elective colorectal surgery: a pooled-analysis with trial sequential analysis

Cited by 3 publications

References 58 publications

Does mechanical bowel preparation really prevent complications after colorectal surgery depending on the lesion localization? A myth or fact?

Does mechanical bowel preparation really prevent complications after colorectal surgery depending on the lesion localization? A myth or fact?

Surgical considerations for the “perfect” colorectal anastomosis

Modified oral antibiotics and mechanical bowel preparation (OAMBP) versus conventional OAMBP for sigmoid colon and rectal surgery: A multicenter randomized non‐inferiority trial

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