Oral Antibiotics Bowel Preparation Without Mechanical Preparation for Minimally Invasive Colorectal Surgeries: Current Practice and Future Prospects

Aziz, Mohamed A Abd El; Grass, Fabian; Calini, Giacomo; Behm, Kevin T.; D’Angelo, Anne-Lise D.; Kelley, Scott R.; Mathis, Kellie L.; Larson, David W.

doi:10.1097/dcr.0000000000002096

Cited by 9 publications

(10 citation statements)

References 25 publications

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“…Multiple studies indicate that the incidence of postoperative complications, such as ALs and SSIs, remains unchanged when using preoperative antibiotic bowel preparation, regardless of whether it is administered with or without MBP. These findings prompt a reassessment of the standard preoperative regimen and suggest that preoperative oAB alone should be considered as the new standard of care [43][44][45][46][47].…”

Section: Discussionmentioning

confidence: 99%

The Impact of Mechanical Bowel Preparation and Oral Antibiotics in Colorectal Cancer Surgery (MECCA Study): A Prospective Randomized Clinical Trial

Frountzas,

Michalopoulou,

Georgiou

et al. 2024

JCM

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Background: Colorectal cancer surgery has been associated with surgical site infections (SSIs), leading to an increase in postoperative morbidity, length of stay and total cost. The aim of the present randomized study was to investigate the relationship between the preoperative administration of oral antibiotic therapy and SSI rate, as well as other postoperative outcomes in patients undergoing colorectal cancer surgery. Material and Methods: Patients who underwent colorectal cancer surgery in a university surgical department were included in the present study. Patients were randomized into two groups using the “block randomization” method. The intervention group received three doses of 400 mg rifaximin and one dose of 500 mg metronidazole per os, as well as mechanical bowel preparation the day before surgery. The control group underwent only mechanical bowel preparation the day before surgery. The study has been registered in ClinicalTrials.gov (NCT03563586). Results: Two hundred and five patients were finally included in the present study, 97 of whom received preoperative antibiotic therapy per os (intervention group). Patients of this group demonstrated a significantly lower SSI rate compared with patients who did not receive preoperative antibiotic therapy (7% vs. 16%, p = 0.049). However, preoperative antibiotic administration was not correlated with any other postoperative outcome (anastomotic leak, overall complications, readmissions, length of stay). Conclusions: Preoperative antibiotic therapy in combination with mechanical bowel preparation seemed to be correlated with a lower SSI rate after colorectal cancer surgery.

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Section: Discussionmentioning

confidence: 99%

The Impact of Mechanical Bowel Preparation and Oral Antibiotics in Colorectal Cancer Surgery (MECCA Study): A Prospective Randomized Clinical Trial

Frountzas,

Michalopoulou,

Georgiou

et al. 2024

JCM

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“…Therefore, we estimated that both the CCI and SD would be higher in patients undergoing rectal surgery than in those undergoing colon surgery. The sample size was calculated with the aim of showing a difference of 5 CCI points between the 2 groups (hypothesis: a mean [SD] 12.5 [18] points in the MOABP group and 17.5 [18] points in the MBP plus pla- cebo group). With a power of 90% and a margin of error of 5%, 574 patients needed to be recruited (Wilcoxon-Mann-Whitney test).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, we estimated that both the CCI and SD would be higher in patients undergoing rectal surgery than in those undergoing colon surgery. The sample size was calculated with the aim of showing a difference of 5 CCI points between the 2 groups (hypothesis: a mean [SD] 12.5 [18] points in the MOABP group and 17.5 [18] points in the MBP plus pla- Categorical variables were compared using the χ 2 test, or Fisher exact test if fewer than 5 cases were expected in a cell. The effect size for categorical variables was estimated using odds ratios (ORs) with 95% CIs.…”

Section: Discussionmentioning

confidence: 99%

“…The global use of oral antibiotics prior to colorectal surgery is highly variable. About 10% of patients undergoing colorectal surgery in Germany receive oral antibiotics, while up to two-thirds of patients in the US are prescribed MOABP …”

Section: Introductionmentioning

confidence: 99%

“…About 10% of patients undergoing colorectal surgery in Germany receive oral antibiotics, while up to two-thirds of patients in the US are prescribed MOABP. 17,18 To our knowledge, no high-quality, large, double-blind RCT assessing MOABP in rectal resection has been published. Because of variable practices and a lack of high-quality evidence regarding the use of oral antibiotics in rectal surgery, we designed and carried out the Mechanical Bowel Preparation and Oral Antibiotics vs Mechanical Bowel Preparation Only Prior to Rectal Surgery (MOBILE2) trial.…”

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confidence: 99%

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Morbidity After Mechanical Bowel Preparation and Oral Antibiotics Prior to Rectal Resection

Koskenvuo,

Lunkka,

Varpe

et al. 2024

JAMA Surg

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ImportanceSurgical site infections (SSIs)—especially anastomotic dehiscence—are major contributors to morbidity and mortality after rectal resection. The role of mechanical and oral antibiotics bowel preparation (MOABP) in preventing complications of rectal resection is currently disputed.ObjectiveTo assess whether MOABP reduces overall complications and SSIs after elective rectal resection compared with mechanical bowel preparation (MBP) plus placebo.Design, Setting, and ParticipantsThis multicenter, double-blind, placebo-controlled randomized clinical trial was conducted at 3 university hospitals in Finland between March 18, 2020, and October 10, 2022. Patients aged 18 years and older undergoing elective resection with primary anastomosis of a rectal tumor 15 cm or less from the anal verge on magnetic resonance imaging were eligible for inclusion. Outcomes were analyzed using a modified intention-to-treat principle, which included all patients who were randomly allocated to and underwent elective rectal resection with an anastomosis.InterventionsPatients were stratified according to tumor distance from the anal verge and neoadjuvant treatment given and randomized in a 1:1 ratio to receive MOABP with an oral regimen of neomycin and metronidazole (n = 277) or MBP plus matching placebo tablets (n = 288). All study medications were taken the day before surgery, and all patients received intravenous antibiotics approximately 30 minutes before surgery.Main Outcomes and MeasuresThe primary outcome was overall cumulative postoperative complications measured using the Comprehensive Complication Index. Key secondary outcomes were SSI and anastomotic dehiscence within 30 days after surgery.ResultsIn all, 565 patients were included in the analysis, with 288 in the MBP plus placebo group (median [IQR] age, 69 [62-74] years; 190 males [66.0%]) and 277 in the MOABP group (median [IQR] age, 70 [62-75] years; 158 males [57.0%]). Patients in the MOABP group experienced fewer overall postoperative complications (median [IQR] Comprehensive Complication Index, 0 [0-8.66] vs 8.66 [0-20.92]; Wilcoxon effect size, 0.146; P &lt; .001), fewer SSIs (23 patients [8.3%] vs 48 patients [16.7%]; odds ratio, 0.45 [95% CI, 0.27-0.77]), and fewer anastomotic dehiscences (16 patients [5.8%] vs 39 patients [13.5%]; odds ratio, 0.39 [95% CI, 0.21-0.72]) compared with patients in the MBP plus placebo group.Conclusions and RelevanceFindings of this randomized clinical trial indicate that MOABP reduced overall postoperative complications as well as rates of SSIs and anastomotic dehiscences in patients undergoing elective rectal resection compared with MBP plus placebo. Based on these findings, MOABP should be considered as standard treatment in patients undergoing elective rectal resection.Trial RegistrationClinicalTrials.gov Identifier: NCT04281667

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Is There a Role for Mechanical and Oral Antibiotic Bowel Preparation for Patients Undergoing Minimally Invasive Colorectal Surgery? A Systematic Review and Meta-analysis

Maatouk

Akid

Kbir

et al. 2023

Journal of Gastrointestinal Surgery

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Oral Antibiotics Bowel Preparation Without Mechanical Preparation for Minimally Invasive Colorectal Surgeries: Current Practice and Future Prospects

Cited by 9 publications

References 25 publications

The Impact of Mechanical Bowel Preparation and Oral Antibiotics in Colorectal Cancer Surgery (MECCA Study): A Prospective Randomized Clinical Trial

The Impact of Mechanical Bowel Preparation and Oral Antibiotics in Colorectal Cancer Surgery (MECCA Study): A Prospective Randomized Clinical Trial

Morbidity After Mechanical Bowel Preparation and Oral Antibiotics Prior to Rectal Resection

Is There a Role for Mechanical and Oral Antibiotic Bowel Preparation for Patients Undergoing Minimally Invasive Colorectal Surgery? A Systematic Review and Meta-analysis

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