Preparación mecánica y profilaxis antibiótica por vía oral en cirugía colorrectal. Análisis de la evidencia científica y revisión narrativa

Badia, Josep M.; Arroyo-García, Nares

doi:10.1016/j.ciresp.2018.03.009

Cirugía Española

2018

DOI: 10.1016/j.ciresp.2018.03.009

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Preparación mecánica y profilaxis antibiótica por vía oral en cirugía colorrectal. Análisis de la evidencia científica y revisión narrativa

Josep M. Badia

Nares Arroyo-García

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Cited by 10 publications

(1 citation statement)

References 51 publications

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“…However, recently there has been resurgent interest in the use of OAB in colorectal surgery, 13 , 14 particularly in light of a large number of retrospective cohort and database studies, many of which originated from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) targeted colectomy database. 15 – 20 Evidence for the role of OAB has been summarized in several narrative reviews 21 , 22 as well as meta-analyses, 23 – 25 which have supported a reduction in SSI associated with combined MBP, OAB, and parenteral antibiotics over MBP and parenteral antibiotics alone. However, the most recent of these studies have been flawed in their inclusion of multiple studies based on the NSQIP database which have large degrees of cross-over of the same study population and have mostly focused upon SSI alone rather than other postoperative outcomes.…”

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confidence: 99%

The Role of Oral Antibiotic Preparation in Elective Colorectal Surgery

et al. 2019

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Objectives To compare the impact of the use of oral antibiotics (OAB) with or without mechanical bowel preparation (MBP) on outcome in elective colorectal surgery. Summary Background Data Meta-analyses have demonstrated that MBP does not impact upon postoperative morbidity or mortality, and as such it should not be prescribed routinely. However, recent evidence from large retrospective cohort and database studies has suggested that there may be a role for combined OAB and MBP, or OAB alone in the prevention of surgical site infection (SSI). Methods A meta-analysis of randomized controlled trials and cohort studies including adult patients undergoing elective colorectal surgery, receiving OAB with or without MBP was performed. The outcome measures examined were SSI, anastomotic leak, 30-day mortality, overall morbidity, development of ileus, reoperation and Clostridium difficile infection. Results A total of 40 studies with 69,517 patients (28 randomized controlled trials, n = 6437 and 12 cohort studies, n = 63,080) were included. The combination of MBP+OAB versus MBP alone was associated with a significant reduction in SSI [risk ratio (RR) 0.51, 95% confidence interval (CI) 0.46–0.56, P < 0.00001, I 2 = 13%], anastomotic leak (RR 0.62, 95% CI 0.55–0.70, P < 0.00001, I 2 = 0%), 30-day mortality (RR 0.58, 95% CI 0.44–0.76, P < 0.0001, I 2 = 0%), overall morbidity (RR 0.67, 95% CI 0.63–0.71, P < 0.00001, I 2 = 0%), and development of ileus (RR 0.72, 95% CI 0.52–0.98, P = 0.04, I 2 = 36%), with no difference in Clostridium difficile infection rates. When a combination of MBP+OAB was compared with OAB alone, no significant difference was seen in SSI or anastomotic leak rates, but there was a significant reduction in 30-day mortality, and incidence of postoperative ileus with the combination. There is minimal literature available on the comparison between combined MBP+OAB versus no preparation, OAB alone versus no preparation, and OAB versus MBP. Conclusions Current evidence suggests a potentially significant role for OAB preparation, either in combination with MBP or alone, in the prevention of postoperative complications in elective colorectal surgery. Further high-quality evidence is required to differentiate between the benefits of combined MBP+OAB or OAB alone.

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The Role of Oral Antibiotic Preparation in Elective Colorectal Surgery

et al. 2019

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Oncologic colorectal surgical site infection: oral or not oral antibiotic preparation, that is the question

Sánchez

Pérez

Saavedra

et al. 2021

Int J Colorectal Dis

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Purpose Surgical wound infection is the most frequent postoperative complication in abdominal surgery, especially at the colorectal level. The aim of this study is analysing the results of mechanical colon preparation combined with oral antibiotic versus mechanical colon preparation without antibiotic therapy in patients with colorectal cancer undergoing elective surgery. Methods This retrospective cohort study had been developed from November 2017 to February 2020. We have included a total of 281 consecutive patients undergoing elective colon and rectal oncological surgeries by the same surgical group using laparoscopic and open approaches. Transanal minimally invasive surgery (TAMIS) and transanal total mesorectal excision (TaTME) approaches were excluded. Exposed patients undergoing colon and rectal cancer surgery received mechanical bowel preparation and oral antibiotics with three doses of neomycin 1 g and erythromycin 500 mg the day before surgery. Results The primary outcome was reduction in surgical wound infection rates before and after starting the oral antibiotic therapy from 17 to 6% (p < 0.05). As a secondary analysis, we evaluated the anastomotic dehiscence rate, corresponding with a decrease from 12 to 3% (p < 0.05). Conclusion Mechanical bowel preparation combined with oral antibiotic therapy is still not unanimously carried out in all the medical hospitals. In this report, we show that mechanical bowel preparation in combination with oral antibiotic reduces the risk of surgical wound infection and anastomotic leakage in patients undergoing colon and rectal cancer surgery.

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The association of health literacy and postoperative complications after colorectal surgery: A cohort study

Theiss¹,

Wood²,

McLeod³

et al. 2022

The American Journal of Surgery

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Preparación mecánica y profilaxis antibiótica por vía oral en cirugía colorrectal. Análisis de la evidencia científica y revisión narrativa

Cited by 10 publications

References 51 publications

The Role of Oral Antibiotic Preparation in Elective Colorectal Surgery

The Role of Oral Antibiotic Preparation in Elective Colorectal Surgery

Oncologic colorectal surgical site infection: oral or not oral antibiotic preparation, that is the question

The association of health literacy and postoperative complications after colorectal surgery: A cohort study

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