Preoperative Bowel Preparation before Elective Bowel Resection or Ostomy Closure in the Pediatric Patient Population Has No Impact on Outcomes: A Prospective Randomized Study

Abstract

The role of preoperative bowel prep in the pediatric surgical population is uncertain. We performed a randomized prospective study to evaluate noninferiority between the presence or absence of a preoperative bowel prep in elective pediatric bowel surgery on postoperative outcomes. Patients aged three months to 18 years were recruited and randomized to the bowel prep group or the no bowel prep group. Patients were evaluated in-hospital and at postoperative clinic visits. Thirty-two patients were recruited; 18 in the bowel prep group and 14 in the no bowel prep group. There was no statistical difference ( P > 0.05) in complications between the groups. Complications were observed in five patients in each group (27.8% and 35.7%, respectively). In the bowel prep group, two (11.1%) had wound infection (vs three, 21.4%), 0 had an intra-abdominal abscess (vs one, 7.1%), one (5.6%) had sepsis (vs one, 7.1%), one (5.6%) had an anastomotic leak (vs 0), and three (16.7%) had a bowel obstruction (vs one, 7.1%). There were no extra-abdominal complications. There were no significant differences in complications between the two groups. Further research is warranted, but may require a multi-institutional trial to recruit sufficient numbers to make conclusions about the significance of the need for bowel prep.

Bowel preparation for elective procedures in children: a systematic review and meta-analysis

“…It should also be noted that in the context of elective surgery, there is growing recognition of the role for proceeding without bowel preparation. 20 …”

Decreasing surgical site infections in pediatric stoma closures

“…Reports on the use of mechanical bowel preparation are variable. The use of mechanical bowel preparation was shown to decrease colostomy closure SSI rates from 45% to 16% in one study [16]; however, other studies have reported no difference in complication rates in pediatric patients receiving bowel preparation and those who do not [17,18]. We also do not utilize subcutaneous drains in ostomy takedown site closure, as studies have shown no difference in SSIs in patients closed primarily with or without a subcutaneous drain [8].…”

Robot‐assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy in children: Step‐by‐step and modifications to UChicago technique

“…We do not use a bowel preparation preoperatively . Patients are encouraged to continue a regular diet until midnight the night before surgery.…”