Oral antibiotic bowel decontamination in open and laparoscopic sigmoid resections for diverticular disease

Abstract

Purpose There is an ongoing debate on whether or not to use oral antibiotic bowel decontamination in colorectal surgery, despite the numerous different regimens in terms of antibiotic substances and duration of application. As we routinely use oral antibiotic bowel decontamination (selective decontamination of the digestive tract (SDD) regimen and SDD regimen plus vancomycin since 2016) in surgery for diverticular disease, our aim was to retrospectively analyze the perioperative outcome in two independent centers. Methods Data from two centers with a routine use of oral antibiotic bowel decontamination for up to 20 years of experience were analyzed for the perioperative outcome of 384 patients undergoing surgery for diverticular disease. Results Overall morbidity was 12.8%, overall mortality was 0.3%, the overall rate of anastomotic leakage (AL) was 1.0%, and surgical site infections (SSIs) were 5.5% and 7.8% of all infectious complications including urinary tract infections and pneumonia. No serious adverse events were related to use of oral antibiotic bowel decontamination. Most of the patients (93.8%) completed the perioperative regimen. Additional use of vancomycin to the SDD regimen did not show a further reduction of infectious complications, including SSI and AL. Conclusion Oral antibiotic decontamination appears to be safe and effective with low rates of AL and infectious complications in surgery for diverticular disease.

Antibiotic Bowel Decontamination in Gastrointestinal Surgery—A Single-Center 20 Years’ Experience

“…The complication rates for sigmoid and rectal cancer surgery were much higher than our previously reported data on surgery for diverticulitis using the same SDD regimen ( 40 ). For rectal cancer surgery, reliable data about outcome measures without the use of antibiotic bowel decontamination are available from a large German cohort with rates for AL of 11.9% and overall in-hospital mortality of 2.1% ( 13 ).…”

“…Compared to the available RCTs and other data on the use of a perioperative SDD regimen in combination with mechanical bowel preparation, our analysis shows similar results regarding rates of infectious complication, SSI, and AL, despite the fact that most of these studies excluded UICC stage IV patients, whereas about 18% of UICC stage IV cases are included in our analysis ( 4 , 5 , 9 , 30 , 49 ). In summary, the relevant data on the use of the perioperative SDD regimen in colorectal surgery support the strategy of topical antibiotics in a reasoned combination ( 4 , 9 , 30 , 39 , 40 ).…”

“…Presently, the beneficial effect of topical antibiotics in the prevention of AL, in our opinion, outweighs the possible adverse side effects. In over 20 years of the use of these modified SDD regimens in gastrectomy and colorectal surgery, no adverse events regarding multidrug-resistant germs or other relevant side effects have been observed ( 30 , 39 , 40 ).…”

“…For patients undergoing gastrectomy, the antimicrobial agents were dissolved in distilled water and administered as a solution per os ( 28 ). Patients with surgery for sigmoid or rectal cancer took these antibiotics as capsules per os ( 40 ). If a diverting stoma was created, an unblocked Foley catheter was placed transanally after the creation of the anastomosis, and antibiotics were then applied topically via the catheter dissolved in distilled water ( 30 ).…”

“…Based on the work by Schardey et al, there is 20 years’ experience in the routine use of antibiotic decontamination in nearly all patients undergoing gastric or colorectal surgery with primary anastomosis ( 28 , 30 , 39 , 40 ). Especially patients with intestinal anastomoses to the esophagus, rectum, and anus have a higher risk for AL compared to other localizations in the gastrointestinal tract ( 10 , 13 , 28 ).…”