Mechanical Bowel Preparation or Not? Outcome of a Multicenter, Randomized Trial in Elective Open Colon Surgery

Fa-Si-Oen, Patrick; Roumen, R. M. H.; Buitenweg, John; Velde, Cornelis van de; Geldere, D. van; Putter, Hein; Verwaest, Charles; Verhoef, L.H.M.; Waard, Jan-Willem D. de; Swank, Dingeman J.; D’Hoore, André; Uchelen, Fred Croiset van

doi:10.1007/s10350-005-0068-y

Cited by 161 publications

(101 citation statements)

References 35 publications

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“…RCTs that stratified the risk of leakage to the site of anastomosis did not find any significant advantage of MBP for surgical procedures with rectal location of the disease. [1][2][3] As stated in our article, 4 we are confident that current literature provides strong evidence that in elective colorectal surgery, no significant benefit is derived from MBP. This applies to all procedures regardless of the site of anastomosis.…”

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confidence: 68%

Mechanical Bowel Preparation for Elective Colorectal Surgery: Is It Enough? Reply

Peppas

Alexiou

Falagas

2009

Journal of Gastrointestinal Surgery

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confidence: 68%

Mechanical Bowel Preparation for Elective Colorectal Surgery: Is It Enough? Reply

Peppas

Alexiou

Falagas

2009

Journal of Gastrointestinal Surgery

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“…However, mechanical bowel preparation liquefies solid faeces, which could increase the risk of intraoperative spillage of contaminant 6,7 . Although some investigators believe that mechanical bowel preparation can reduce the bacterial load in the bowel, the large number of microorganisms in the digestive tract makes this almost impossible 8,9 . Mechanical bowel preparation has been shown to have Among non-surgical post-operative complications UTI was high in group A followed by respiratory and cardiac ones.…”

Section: Discussionmentioning

confidence: 99%

Role of Mechanical Bowel Preparation in Preventing Anastomotic Leakage in Elective Colo-rectal Surgery

Ahmad¹,

Biswas²

2018

Faridpur Med Coll J

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Abstract:Mechanical bowel preparation is routinely done before colorectal surgeries to reduce morbidity and mortality all over the world. The role of mechanical bowel preparation in preventing complications is recently disputed. The aim of the study was to assess whether elective colorectal surgery can be performed without mechanical bowel preparation. This cross sectional comparative study was carried out to assess the role of mechanical bowel preparation in post-operative complications in elective colon and rectal surgery in the department of surgery of Bangabandhu Sheikh Mujib Medical University, Dhaka Medical College Hospital and SSMC-Mitford Hospital during the period of 1 st January 2007 to 31 st December 2007. Fifty patients undergoing surgery for carcinoma of colon and rectum were included in the study. Patients were allocated in two groups by non-probability convenient consecutive technique-one group with mechanical bowel preparation with polyethylene glycol and one group with no preparation before surgery. All patients in the study group were followed up for at least one month after surgery for wound infection, anastomotic leakage and intra-abdominal infection. Total 50 patients were randomly divided into two groups (group A, 25 patients & Group B, 25 patients). Group A was the preparatory group and Group B was the non-preparatory group. The type of surgical procedure and the type of anastomosis did not differ significantly between two groups. Sixty percent patients of group A developed post-operative complications; on the other hand 40% patients of group B developed post-operative complications. My study proved that no advantage is gained by pre-operative mechanical bowel preparation and can be easily avoided in order to save the patient from unwanted events like nausea, vomiting, electrolyte imbalance and also increased chance of post-operative complication.

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“…The first update included four new trials 17,21,29,30 and total 830 patients: 414 in Group A and 416 in Group B. Heterogeneous clinical outcomes were observed, but the authors suggested to skip the mechanical bowel preparation, as it would be associated with higher incidence anastomotic dehiscence in colorectal surgery.…”

Section: Description Of Trialsmentioning

confidence: 99%

“…(Figures 1 and 2). [24][25][26][27][28][29][30][31][32][33][34][35][36] ( Table 3 and Figures 1 and 2 The funnel plots for clinical outcomes -overall anastomotic dehiscence and operatory wound infection -did not significant asymmetry and, consequently, no publication bias (Figure 3). 40 published their study, demonstrating in a randomized clinical trial that bowel preparation does not reduce the risks of anastomotic dehiscence, they were vehemently criticized by one of the magazine editors 41 .…”

Section: Description Of Trialsmentioning

confidence: 99%

Preoperative mechanical bowel preparation in elective colorectal surgery: an update of systematic review of the literature and meta-analysis

Güenaga¹,

Matos²,

Wille‐Jørgensen³

2012

J. Coloproctol. (Rio J.)

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Güenaga KF, Matos D, Wille-Jørgensen P. Preoperative mechanical bowel preparation in elective colorectal surgery. An update of systematic review of the literature and meta-analysis. J Coloproctol, 2012;32(1): 7-17. AbstrACt:The belief that mechanical bowel preparation is related to the reduction of complications in elective colorectal surgery is based on observational studies and expert opinion. This question led the authors to a systematic literature review, with the completion of meta-analysis, followed by three updates. Method: The sources of information were EMBASE, LILACS, MEDLINE, IBECS, the Cochrane Controlled Trials Register and letters to the authors. The studies were included according to the randomization criteria. The studied variables were: anastomotic dehiscence, mortality and operatory wound infection. The analysis was divided into two comparisons: one group with mechanical preparation (Group A) compared with a group without preparation (Group B) (Comparison I) and a group submitted to rectal enema (Comparison II). results: We analyzed 5,805 patients in 20 clinical trials. In comparison I, anastomotic leak occurred in 4.4% (101/2,275 patients) in Group A and 4.5% (103/2,258 patients) in Group B. In comparison II, anastomotic leak occurred in 4.4% (27/601 patients) in Group A and 3.4% (21/609 patients) in Group B. Conclusion: Despite the inclusion of more studies, evidences found in studies did not show any benefit obtained from the use of preoperative mechanical bowel preparation or rectal cleansing enemas in elective colorectal surgery.Keywords: colorectal surgery; review; meta-analysis; postoperative complications; anastomotic leak. resuMO: A crença de que o preparo mecânico do cólon está relacionado à diminuição de complicações na cirurgia colorretal eletiva é baseada em estudos observacionais e opinião de especialistas. Seu questionamento motivou os autores na busca sistemática da literatura, com a realização de meta-análise, seguida de três atualizações. Método: Fontes de informação foram EMBASE, LILACS, MEDLINE, IBECS, Registros de Ensaios Clínicos Casualizados da Colaboração Cochrane e cartas para os autores. Os estudos foram incluídos de acordo com os critérios de casualização. Os desfechos clínicos estudados foram: deiscência anastomótica, mortalidade e infecção da ferida operatória. A análise dos grupos foi dividida em duas comparações: comparação I, grupo submetido a preparo mecânico do cólon (Grupo A) comparado ao grupo sem preparo (Grupo B); comparação II, Grupo A, submetido a preparo do cólon e Grupo B, realizado apenas enema retal. resultados: Foram analisados 5.805 doentes em 20 ensaios clínicos. Na comparação I, deiscência anastomótica ocorreu em 4,4% (101/2.275 doentes) no Grupo A e 4,5% (103/2.258 doentes) no Grupo B. Na comparação II, deiscência anastomótica ocorreu em 4,4% (27/601 doentes) no Grupo A e 3,4% (21/609 doentes) no Grupo B. Conclusão: Apesar da inclusão de mais estudos, as evidências encontradas não demonstraram benefício no uso do preparo mecânico pré-operatório d...

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Mechanical Bowel Preparation or Not? Outcome of a Multicenter, Randomized Trial in Elective Open Colon Surgery

Cited by 161 publications

References 35 publications

Mechanical Bowel Preparation for Elective Colorectal Surgery: Is It Enough? Reply

Mechanical Bowel Preparation for Elective Colorectal Surgery: Is It Enough? Reply

Role of Mechanical Bowel Preparation in Preventing Anastomotic Leakage in Elective Colo-rectal Surgery

Preoperative mechanical bowel preparation in elective colorectal surgery: an update of systematic review of the literature and meta-analysis

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