Preoperative bowel preparation does not favor the management of colorectal anastomotic leak

Abstract

BACKGROUND Controversy exists regarding the impact of preoperative bowel preparation on patients undergoing colorectal surgery. This is due to previous research studies, which fail to demonstrate protective effects of mechanical bowel preparation against postoperative complications. However, in recent studies, combination therapy with oral antibiotics (OAB) and mechanical bowel preparation seems to be beneficial for patients undergoing an elective colorectal operation. AIM To determine the association between preoperative bowel preparation and postoperative anastomotic leak management (surgical vs non-surgical). METHODS Patients with anastomotic leak after colorectal surgery were identified from the 2013 and 2014 Colectomy Targeted American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database and were employed for analysis. Every patient was assigned to one of three following groups based on the type of preoperative bowel preparation: first group-mechanical bowel preparation in combination with OAB, second group-mechanical bowel preparation alone, and third group-no preparation. RESULTS A total of 652 patients had anastomotic leak after a colectomy from January 1, 2013 through December 31, 2014. Baseline characteristics were assessed and found that there were no statistically significant differences between the three groups in terms of age, gender, American Society of Anesthesiologists score, and other preoperative characteristics. A χ 2 test of homogeneity was conducted and there was no statistically/clinically significant difference between the three categories of bowel preparation in terms of reoperation. CONCLUSION The implementation of mechanical bowel preparation and antibiotic use in patients who are going to undergo a colon resection does not influence the treatment of any possible anastomotic leakage.

Bowel preparation for elective colectomy in Crohn's disease: results from a global cohort study using the NSQIP database

“…Nevertheless, there are retrospective studies that suggest mechanical preparation is expendable and patients who receive only antibiotics have the same outcomes as those who receive both preparations [8, 28]. There is also a study that concluded that mechanical and antibiotic colon preparations do not have influence on the risk of anastomotic leak [29] and another study that concluded that both preparations combined are not efficient for reducing surgical site infection or morbidity [30].…”

Evaluating the Role of Mechanical Bowel Preparation in Anterior Resection Through a Prospective Randomized Single-Blinded Trial

“…Previous research on the efficacy of MBP in colorectal surgery has produced inconclusive results. Inadequate bowel preparation has been associated with similar leak rates between unprepared and poorly prepared patients, likely due to increased bowel content and compromised intraoperative handling [ 18 ]. In our study, all patients were admitted 48 hours before surgery, bowel preparation started 24 hours before surgery, and their effluent was evaluated.…”

Selective decontamination of the digestive tract in colorectal surgery reduces anastomotic leakage and costs: a propensity score analysis

“…Many convincing studies suggest that MBP alone is not effective in improving postoperative outcomes and may also harm the patient. It should therefore be administered in combination with antibiotics [18][19][20][21]. Nevertheless, from a surgical point of view, MBP is preferable in terms of cleaner and easier handling during and after operational procedures.…”