Multicentre randomized clinical trial of mechanical bowel preparation in elective colonic resection

Jung, B.; Påhlman, Lars; Nyström, P-O; Nilsson, Erik

doi:10.1002/bjs.5816

Cited by 222 publications

(152 citation statements)

References 40 publications

(49 reference statements)

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“…However, a large multicenter study and a review conducted by the Cochrane Collaboration found that there was no difference in the fistula rate or severity of infectious complications when comparing a group that used mechanical bowel preparation and another group that did not use it (23)(24) .…”

Section: Discussionmentioning

confidence: 99%

Surgical site infection and its risk factors in colon surgeries

Fusco

Massarico

Alves

et al. 2016

Rev. esc. enferm. USP

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Objective:To identify the occurrence of surgical site infection (SSI) and its risk factors in patients undergoing colon surgery in a tertiary hospital located in the countryside of the state of São Paulo. Method: Retrospective cohort study, with collection of information contained in the medical records of patients undergoing colon surgery in the period between January 2010 and December 2013. The studied variables were the possible risk factors related to the patient, to demographic characteristics and the surgical procedure. Results: In total, were evaluated 155 patients with an overall SSI incidence of 16.7%. A statistically significant association was found both in the univariate as in the multivariate analysis between the SSI and the following variables: male gender, Charlson index and mechanical bowel preparation. Conclusion: The understanding of health professionals about the factors that influence the incidence of SSI in colon surgery may contribute to the quality of care provided to surgical patients, from effective actions to minimize the risk of infections. DESCRIPTORSSurgical Wound Infection; Colorectal Surgery; Perioperative Nursing. Surgical site infection and its risk factors in colon surgeriesInfecção de sítio cirúrgico e seus fatores de risco em cirurgias de cólon Infección de sitio quirúrgico y sus factores de riesgo en cirugías de colon

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Section: Discussionmentioning

confidence: 99%

Surgical site infection and its risk factors in colon surgeries

Fusco

Massarico

Alves

et al. 2016

Rev. esc. enferm. USP

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“…Bowel preparation is known potentially to cause significant fluid shifts that may result in dehydration and electrolyte deficiencies. 30 Two RCTs have shown no benefit with the routine use of bowel preparation in elective colorectal surgery 31,32 with another suggesting an increased risk of postoperative anastomotic breakdown. 33 The evidence for avoiding routine nasogastric tube decompression and implementation of epidural anaesthesia postoperatively has been ratified by meta-analyses.…”

Section: Discussionmentioning

confidence: 99%

A systematic review of enhanced recovery protocols in colorectal surgery

Rawlinson

Kang

Evans

et al. 2011

annals

136

103

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INTRODUCTION Colorectal surgery has been associated with a complication rate of 15-20% and mean postoperative inpatient stays of 6-11 days. The principles of enhanced recovery after surgery (ERAS) are well established and have been developed to optimise perioperative care and facilitate discharge. The purpose of this systematic review is to present an updated review of perioperative care in colorectal surgery from the available evidence and ERAS group recommendations. METHODS Systematic searches of the PubMed and Embase ™ databases and the Cochrane library were conducted. A hand search of bibliographies of identified studies was conducted to identify any additional articles missed by the initial search strategy. RESULTS A total of 59 relevant studies were identified. These included six randomised controlled trials and seven clinical controlled trials that fulfilled the inclusion criteria. These studies showed reductions in duration of inpatient stays in the ERAS groups compared with more traditional care as well as reductions in morbidity and mortality rates. CONCLUSIONS Reviewing the data reveals that ERAS protocols have a role in reducing postoperative morbidity and result in an accelerated recovery following colorectal surgery. Similarly, both primary and overall hospital stays are reduced significantly. However, the available evidence suggests that ERAS protocols do not reduce hospital readmissions or mortality. These findings help to confirm that ERAS protocols should now be implemented as the standard approach for perioperative care in colorectal surgery.

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“…Mechanical bowel preparation contributes to preoperative dehydration and is unpleasant for the patient. 5,6 Recent evidence suggests that MBP does not decrease anastomotic leakage, wound infection, or mortality (for the majority of patients), 7 and it may even have a tendency towards a higher incidence of spillage of bowel contents due to formed stool being replaced by liquid bowel contents. 8 The patient population in which MBP is indicated is still a matter of debate amongst surgeons, and it is often given for ''handling'' reasons, with some surgeons arguing that MBP facilitates easier laparoscopic surgery.…”

Section: Preoperative Fluid Managementmentioning

confidence: 99%

Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS)

Miller

Roche

Mythen

2014

Can J Anesth/J Can Anesth

219

137

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Optimal perioperative fluid management is an important component of Enhanced Recovery After Surgery (ERAS) pathways. Fluid management within ERAS should be viewed as a continuum through the preoperative, intraoperative, and postoperative phases. Each phase is important for improving patient outcomes, and suboptimal care in one phase can undermine best practice within the rest of the ERAS pathway. The goal of preoperative fluid management is for the patient to arrive in the operating room in a hydrated and euvolemic state. To achieve this, prolonged fasting is not recommended, and routine mechanical bowel preparation should be avoided. Patients should be encouraged to ingest a clear carbohydrate drink two to three hours before surgery. The goals of intraoperative fluid management are to maintain central euvolemia and to avoid excess salt and water. To achieve this, patients undergoing surgery within an enhanced recovery protocol should have an individualized fluid management plan. As part of this plan, excess crystalloid should be avoided in all patients. For low-risk patients undergoing low-risk surgery, a ''zero-balance'' approach might be sufficient. In addition, for most patients undergoing major surgery, individualized goal-directed fluid therapy (GDFT) is recommended. Ultimately, however, the additional benefit of GDFT should be determined based on surgical and patient risk factors. Postoperatively, once fluid intake is established, intravenous fluid administration can be discontinued and restarted only if clinically indicated. In the absence of other concerns, detrimental postoperative fluid overload is not justified and ''permissive oliguria'' could be tolerated.Résumé La gestion périopératoire optimale des liquides est un élément important des programmes de récupération rapide après la chirurgie (RRAC). La gestion des liquides dans le cadre de la RRAC doit être vue comme un continuum au travers des phases pré-, per-et postopératoires. Chaque phase est importante pour améliorer la condition du patient et des soins sous-optimaux au cours d'une de ces phases peuvent miner les meilleures pratiques déployées tout au long de la RRAC. L'objectif de la gestion préopératoire des liquides est de faire en sorte que le patient entre en salle d'opération correctement hydraté et dans un état euvolémique. Pour y parvenir, un jeûne prolongé n'est pas recommandé et le nettoyage mécanique de l'intestin est à éviter. Les patients doivent être encouragés à absorber une boisson claire riche en hydrates de carbone, deux à trois heures avant la chirurgie. Les buts de la gestion peropératoire des liquides sont de maintenir une euvolémie centrale et d'éviter un excès de sel et d'eau. Pour y parvenir, les patients subissant une intervention chirurgicale dans le cadre d'un protocole de récupération rapide devraient avoir un programme personnalisé de gestion des liquides. Dans le cadre de ce plan, l'excès de cristalloïdes doit être évité chez tous les patients. Pour des patients à faible risque subissant une intervention c...

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Multicentre randomized clinical trial of mechanical bowel preparation in elective colonic resection

Abstract: ISRCTN28535118 (http://www.controlled-trials.com).

Cited by 222 publications

References 40 publications

Surgical site infection and its risk factors in colon surgeries

Surgical site infection and its risk factors in colon surgeries

A systematic review of enhanced recovery protocols in colorectal surgery

Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS)

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