The Controversies of Mechanical Bowel and Oral Antibiotic Preparation in Elective Colorectal Surgery

Rollins, Katie E.; Lobo, Dileep N.

doi:10.1097/sla.0000000000003985

Cited by 14 publications

(15 citation statements)

References 13 publications

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“…Furthermore, there is still controversy [32] and there is no unanimous criterion on MBP and OA in our country [33]. More specifically, in Spain, it was stated that there was no evidence of the benefits of MBP in elective colorectal surgery after a joint review, being considered unnecessary, even that it could increase the risk of anastomotic leakage and even SSI [34] [35].…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

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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show abstract

“…The suggestion to omit this from the protocol, if possible, especially in frail patients, is supported by a meta-analysis that revealed an advantage to nobowel preparation with regard to anastomotic leakage, intraabdominal infections, and wound infections [69]. In this context the role of perioperative prophylactic antibiotics usage is studied, which may have a preventive effect on surgical site infections, anastomotic leakage and mortality [70].…”

Section: Preoperative Carementioning

confidence: 99%

Preoperative risk factors for major postoperative complications after complex gastrointestinal cancer surgery: A systematic review

Kooten

Bahadoer

Peeters

et al. 2021

European Journal of Surgical Oncology

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Patients undergoing complex gastrointestinal surgery are at high risk of major postoperative complications (e.g., anastomotic leakage, sepsis), classified as Clavien-Dindo (CD) ! IIIa. Identification of preoperative risk factors can lead to the identification of high-risk patients. These risk factors can also be used to design personalized perioperative care. This systematic review focuses on the identification of these factors. The Medline and Embase databases were searched for prospective, retrospective cohort studies and randomized controlled trials investigating the effect of risk factors on the occurrence of major postoperative complications and/or mortality after complex gastrointestinal cancer surgery. Risk of bias was assessed using the Quality in Prognostic Studies tool. The level of evidence was graded based on the number of studies reporting a significant association between risk factors and major complications. A total of 207 eligible studies were retrieved, identifying 33 risk factors for major postoperative complications and 13 preoperative laboratory results associated with postoperative complications. The present systematic review provides a comprehensive overview of preoperative risk factors associated with major postoperative complications. A wide range of risk factors are amenable to actions in perioperative care and prehabilitation programs, which may lead to improved outcomes for high-risk patients. Additionally, the knowledge of this study is important for benchmarking surgical outcomes.

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“…The authors noted that the positive benefits from retrospective cohort and database studies were tempered when evidence from RCTs alone were considered [49]. Furthermore, there was a need to differentiate between the benefits of combined MBP and OAB, and OAB alone [49,50]. Overall, the ERAS guidelines currently recommend against the use of routine preoperative bowel preparation in colonic surgery [51].…”

Section: Bowel Preparationmentioning

confidence: 99%

Enhanced recovery after surgery: Current status and future progress

Rollins

Lobo

Joshi

2021

Best Practice & Research Clinical Anaesthesiology

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The Controversies of Mechanical Bowel and Oral Antibiotic Preparation in Elective Colorectal Surgery

Cited by 14 publications

References 13 publications

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

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

Preoperative risk factors for major postoperative complications after complex gastrointestinal cancer surgery: A systematic review

Enhanced recovery after surgery: Current status and future progress

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