Mechanical Bowel Preparation Does Not Affect Anastomosis Healing in an Experimental Rat Model

Abstract

BackgroundMechanical bowel preparation before colorectal surgery is commonly performed, but its benefits are controversial. The aim of this study was to compare the effects of mechanical bowel preparation on healing of colonic anastomosis and tissue strength.Material/MethodsAfter institutional review board approval, 20 adult Wistar albino rats were randomly divided into 2 groups of 10 animals each. Mechanical bowel preparation including sodium phosphate was performed on the experimental group via a feeding tube, whereas no bowel preparation procedures were performed on the control group. Transverse colon resection and anastomosis were performed on all rats under general anaesthesia. On postoperative day 5, re-laparotomy was performed and the anastomotic areas were resected. Animals were killed, after which bursting pressure and tissue hydroxyproline concentrations were measured, histopathological examination was performed, and we evaluated and compared the results.ResultsThere were no differences between control and experimental groups in bursting pressure, tissue hydroxyproline concentrations, or histopathological examination results (P>0.05).ConclusionsOur study demonstrated no significant difference between bursting pressures, tissue hydroxyproline levels, or modified wound healing score at postoperative day 5 between rats undergoing and not undergoing mechanical bowel preparation. Mechanical bowel preparation is not essential for healing or strength of colonic anastomosis in rats.

Bowel Preparation in Pediatric Colorectal Surgery, Can We Move On? Historical and Literature Review

“…By 1970s, mechanical colon preparation had been adopted as routine procedure amongst the majority of surgeons. 17 In 1973, Nichols-Condon's bowel preparation using neomycin, erythromycin, and mechanical preparation was conducted as standard treatment. It was proven to improve intraluminal and mucosal antibiotic concentration.…”

“…Thus, despite the accepted theory that bowel preparation will increase antibiotic efficacy by reducing fecal mass and reducing bacterial colonization which is expected to lower infection risk, and minimalizing mechanical wound, studies conducted in pediatric population show ambiguous benefit and weak correlation in post-operative complications. 17,20,21 One study reported that bowel preparation even increased the risk of infection in stoma closing procedure. 23 Bowel preparation might pose harmful effects on pediatric population, even though one study found that bowel preparation was associated with inflammation process that might correlate with better healing.…”

MECHANICAL AND MANUAL ANASTOMOSES IN COLORECTAL SURGERY (review)

“…Ряд хирургов считают её обязательной процедурой [64,76]. В то же время, немало сообщений, где не было обнаружено разницы в частоте несостоятельности анастомозов, инфекционных осложнений, сроках пребывания в стационаре между больными, получавшими механическую очистку кишечника и больным без подготовки [46][47][48]64,65], с другой стороны, существуют многочисленные публикации об эффективности механической очистки кишечника в эксперименте у животных [54,57,61]. Было изучено отношение к механическим анастомозам с помощью степлеров 241 хирургов-гастроэнтерологов в Японии [49].…”