Mechanical Bowel Preparation Does Not Affect Clinical Severity of Anastomotic Leakage in Rectal Cancer Surgery

Abstract

MBP was not found to affect the clinical severity of anastomotic leakage in elective rectal cancer surgery.

Impact of mechanical bowel preparation in elective colorectal surgery: A meta-analysis

“…When MBP was compared with no MBP (including no preparation at all and those who underwent a single rectal enema), there was no difference in the incidence of anastomotic leak (OR = 0.90, 95%CI: 0.74 to 1.10, P = 0.32). When MBP vs absolutely no MBP was analysed[ 29 , 40 , 46 , 48 - 50 , 52 , 54 - 65 , 68 , 70 , 71 , 73 ], this made no difference to anastomotic leak rates (OR 0.94, 95% CI 0.70 to 1.25, P = 0.67), nor when MBP was compared with a single rectal enema[ 37 , 45 , 47 , 51 , 53 , 66 , 67 , 69 , 72 , 74 , 76 , 77 ] (OR = 0.92, 95%CI: 0.70 to 1.20, P = 0.52).…”

“…When randomised controlled trials alone were included in the analysis[ 37 , 40 , 45 - 65 ] (Supplementary figure 1A), the use of MBP vs no MBP did not affect the incidence of anastomotic leak (OR = 1.02, 95%CI: 0.75 to 1.40, P = 0.90), nor when MBP vs absolutely no MBP[ 40 , 46 , 48 - 50 , 52 , 54 - 65 ] or MBP vs single rectal enema[ 37 , 45 , 47 , 51 , 53 ]were considered. When observational studies alone were analysed[ 66 - 73 , 76 , 77 ] (Supplementary figure 1B), the use of MBP vs no MBP did significantly affect the incidence of anastomotic leak (OR = 0.76, 95%CI: 0.63 to 0.91, P = 0.003), although this was not significant when MBP vs single rectal enema[ 66 , 67 , 69 , 72 , 74 , 76 , 77 ] and MBP vs absolutely no MBP[ 29 , 68 , 70 , 71 , 73 ] were considered separately.…”

“…A total of 20 studies on 16742 patients[ 29 , 40 , 46 , 49 , 51 - 57 , 59 , 65 , 68 , 69 , 71 , 72 , 74 , 76 , 77 ] examined the impact of MBP upon reoperation rates (Figure 7 ). Overall the use of MBP vs no MBP did not impact upon requirement for reoperation[ 29 , 40 , 46 , 49 , 51 - 57 , 59 , 65 , 68 , 69 , 71 , 72 , 74 , 76 , 77 ] (OR = 0.91, 95%CI: 0.75 to 1.12, P = 0.38), nor when MBP vs a single rectal enema[ 51 , 53 , 69 , 72 , 74 , 76 , 77 ] (OR = 0.82, 95%CI: 0.42 to 1.60, P = 0.56) or MBP vs absolutely no preparation[ 29 , 40 , 46 , 49 , 52 , 54 - 57 , 59 , 65 , 68 , 71 ] (OR = 0.85, 95%CI: 0.72 to 1.01, P = 0.06) were compared.…”

“…When only randomised controlled trials were examined[ 40 , 46 , 49 , 51 - 57 , 59 , 65 ] (Supplementary figure 6A), again no difference was seen by the use of MBP, a single rectal enema or absolutely no preparation. When observational studies were examined[ 29 , 68 , 69 , 71 , 72 , 74 , 76 , 77 ] (Supplementary figure 6B) overall MPB resulted in no significant reduction in the reoperation rate vs those who did not have bowel preparation but may have had a rectal enema (OR = 0.86, 95%CI: 0.64 to 1.15, P = 0.30), as well as when those who has a single rectal enema (OR = 0.82, 95%CI: 0.44 to 1.52, P = 0.52), however a significant difference was seen when MBP was compared with patients who received absolutely no preparation (OR = 0.78, 95%CI: 0.63 to 0.97, P = 0.02).…”

Complications of laparoscopic rectal cancer surgery

“…The use of preoperative mechanical bowel preparation, remains controversial, and a recent review of 1,369 patients who underwent elective rectal cancer resection demonstrated a significantly lower rate of clinical anastomotic leak in the group who had surgery without mechanical bowel preparation [21] . The value of a defunctioning stoma is still not clear.…”