Mechanical bowel preparation for esophagocoloplasty in children: is it really necessary?

Abstract

Esophagocoloplasty is a commonly performed procedure for esophageal replacement in children. Traditionally, mechanical bowel preparation (MBP) is performed before this operation. However, this practice has been questioned, initially in adults and now in children. The aim of this study was to evaluate the influence of MBP on esophagocoloplasty in a series of children. Data collected from 164 patients who underwent esophagocoloplasty in the Pediatric Surgery Division, University of São Paulo Medical School, from February 1978 to July 2011 were reviewed for postoperative complications. In 134 patients, at least one kind of MBP was performed before the surgery (PREP group). MBP was omitted in 30 patients (NO-PREP group). There was no statistical difference between the groups in the rates of evisceration, colocolic, or cologastric anastomotic dehiscence and death. However, in the NO-PREP group, the incidence of cervical leakage (6.6%) was significantly decreased in comparison with the classical PREP group (25.3%) (P= 0.03). The results of this study suggest that the omission of MBP has a positive impact on the incidence of postoperative complications in esophagocoloplasty.

Surgical Antimicrobial Prophylaxis in Abdominal Surgery for Neonates and Paediatrics: A RAND/UCLA Appropriateness Method Consensus Study

“…To date, no studies have been conducted on large paediatric and neonatal series concerning perioperative antibiotic prophylaxis in this type of intervention. In a retrospective study on the use of mechanical bowel preparation in children that were undergoing oesophageal-colon-plastic surgery, the use of ampicillin, amikacin, and metronidazole was reported from 48 h before to 7 days after surgery [ 104 ]. Being a clean-contaminated surgery with opening of the gastrointestinal tract, other groups also recommend the use of perioperative antibiotic prophylaxis with cefazolin (30–50 mg/kg, with a possible additional dose of 25 mg/kg in cases of surgery lasting more than 4 h) and metronidazole (15 mg/kg in single administration) in combination [ 100 ].…”

Experience in reconstruction of esophagus, epiglottis, and upper trachea due to caustic injuries in pediatric patients and establishment of algorithm

“…According to previous studies, leakage rates from anastomosis sites between the remnant esophagus and transposed colon are between 6.6% and 28.3% in the pediatric population (Gallo et al, 2012; Leal et al, 2013; Tannuri & Tannuri, 2017). In contrast, leakage rates from the anastomosis sites between the remnant esophagus and pedicled jejunum after jejunal flap interposition were much higher (18.4%–53.9%; Bairdain et al, 2016; Bax & van der Zee, 2007; Gallo et al, 2012; Kunisaki & Coran, 2017).…”

The effect of preoperative mechanical bowel preparation in paediatric bowel surgery on postoperative wound related complications: A meta‐analysis

“…33 Meanwhile, MBP is not without any potential complications. Histologically, patients using MBP have been found to have intestines that show a loss of mucus and epithelial cells, as well as inflammatory changes within intestinal wall, 34 damaging intestinal mucosal barrier, 5 altering composition of common intestinal microbiota, and affecting intestinal function 27,35 Contrary to the basic principles of MBP, some studies have even found that MBP liquefies fixed faeces in intestine, increasing the chances of intraoperative spillage and contamination. 29,36 If MBP results in significant water loss, patients may experience dehydration symptoms, including thirst, urine decreased, fatigue, etc.…”

“…Several comprehensive and large-scale meta-analyses have shown that MBP in adult elective bowel surgery does not reduce postoperative complications such as anastomotic leakage, 31 surgical site infections, intraabdominal infections, 9 and intestinal obstruction. 32 In addition, recent studies have found that under general anaesthesia and just before the operation, bowel irrigation can be easily and safely performed in the operating room, 27 and this nursing operation can be eliminated before paediatric surgery. 33 Meanwhile, MBP is not without any potential complications.…”