Updated Systematic Review and Meta-Analysis of Randomized Clinical Trials on the Role of Mechanical Bowel Preparation Before Colorectal Surgery

Slim, K.; Vicaut, Éric; Launay-Savary, M.-V.; Contant, Caroline M. E.; Chipponi, J

doi:10.1097/sla.0b013e318193425a

Cited by 308 publications

(179 citation statements)

References 23 publications

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“…54 With this in mind, Slim and colleagues published an updated meta-analysis and review of the literature which included 14 RCTs and nearly 5000 patients. 61 Although it did not confirm the harmful effect of MBP as previously suggested, it demonstrated that any kind of MBP can safely be omitted before colonic surgery.…”

Section: Role Of Mechanical Bowel Preparationmentioning

confidence: 42%

Enhanced recovery after surgery (ERAS) protocols: Time to change practice?

Melnyk

Casey

Black

et al. 2013

CUAJ

262

120

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Radical cystectomy with pelvic lymph node dissection remains the standard treatment for patients with muscle invasive bladder cancer. Despite improvements in surgical technique, anesthesia and perioperative care, radical cystectomy is still associated with greater morbidity and prolonged in-patient stay after surgery than other urological procedures. Enhanced recovery after surgery (ERAS) protocols are multimodal perioperative care pathways designed to achieve early recovery after surgical procedures by maintaining preoperative organ function and reducing the profound stress response following surgery. The key elements of ERAS protocols include preoperative counselling, optimization of nutrition, standardized analgesic and anesthetic regimens and early mobilization. Despite the significant body of evidence indicating that ERAS protocols lead to improved outcomes, they challenge traditional surgical doctrine, and as a result their implementation has been slow.The present article discusses particular aspects of ERAS protocols which represent fundamental shifts in surgical practice, including perioperative nutrition, management of postoperative ileus and the use of mechanical bowel preparation.

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Section: Role Of Mechanical Bowel Preparationmentioning

confidence: 42%

Enhanced recovery after surgery (ERAS) protocols: Time to change practice?

Melnyk

Casey

Black

et al. 2013

CUAJ

262

120

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“…Secondary endpoints examined complications inclusive of abscesses, wound infections, sepsis, reoperations and death. Results demonstrated no statistically signifi cant difference with respect to leak rates (p = 0.46), abdominal abscesses (p = 0.75), wound infections (p = 0.11), extra-abdominal sepsis (p = 0.12), reoperations (p = 0.63) or death (p = 0.70) [15]. The American Society of Colorectal Surgeons (ASCRS) support this by stating, "All types of mechanical preparation occasionally engender serious complications [16][17][18].…”

Section: Preoperative Bowel Preparationmentioning

confidence: 92%

“…No benefi t to MBP was seen and, in addition, several trials demonstrated increased morbidity with the use of MBP. In an updated 2009 metaanalysis, Slim et al examined 14 RCTs with a total of 4,859 patients undergoing colonic resection exclusively without inclusion of rectal cancer patients [15]. These patients were divided into two groups; 2,452 who had MBP and 2,407 who did not.…”

Section: Preoperative Bowel Preparationmentioning

confidence: 99%

Surgical management of colorectal cancer: A review of the literature

Abdel‐Misih

Bloomston

2009

Indian J Surg

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Background Colon cancer management continues to evolve with signifi cant advances in chemotherapy, surgical technique and palliative interventions. As the options of therapy have improved, so have the challenges of management of primary colon cancer. Review A review of historical and up to date literature was undertaken utilising Medline/PubMed to examine relevant topics of interest-related to the surgical management. Enhanced knowledge of genetics associated with colon cancer has improved our care of patients with hereditary colon cancer syndromes. Additionally, traditional approaches to surgical intervention for primary colon cancer have been questioned and will be discussed in this review including the role of laparoscopy, use of mechanical bowel preparation, management of the primary tumour in the face of metastatic disease, as well as the role of palliative intervention in select patients. Conclusion Colon cancer has seen improvement and expansion of therapeutic approaches to primary colon cancer. Laparoscopy and palliative interventions have become widely accepted with level I evidence to demonstrate good patient outcomes. Traditional dogma with mechanical bowel preparation has been challenged and debunked with

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“…anastomotic leakage, surgical-site infections etc.) In addition, there is a trend for increased complications for patients undergoing bowel preparation [45][46][47]. The largest metaanalysis, including almost 5,000 patients, demonstrated with a high level of evidence that all kinds of mechanical bowel preparation should be omitted before colonic surgery [46].…”

Section: (100% [Strong Consensus]; Gor C: 100% [Strong Consensus])mentioning

confidence: 99%

Laparoscopic extraperitoneal rectal cancer surgery: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES)

et al. 2011

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Background The laparoscopic approach is increasingly applied in colorectal surgery. Although laparoscopic surgery in colon cancer has been proved to be safe and feasible with equivalent long-term oncological outcome compared to open surgery, safety and long-term oncological outcome of laparoscopic surgery for rectal cancer remain controversial. Laparoscopic rectal cancer surgery might be efficacious, but indications and limitations are not clearly defined. Therefore, the European Association for Endoscopic Surgery (EAES) has developed this clinical practice guideline. Methods An international expert panel was invited to appraise the current literature and to develop evidence-based recommendations. The expert panel constituted for a consensus development conference in May 2010. Thereafter, the recommendations were presented at the annual congress of the EAES in Geneva in June 2010 in a plenary session. A second consensus process (Delphi process) of the recommendations with the explanatory text was necessary due to the changes after the consensus conference. Results Laparoscopic surgery for extraperitoneal (midand low-) rectal cancer is feasible and widely accepted. The laparoscopic approach must offer the same quality of surgical specimen as in open surgery. Short-term outcomes such as bowel function, surgical-site infections, pain and hospital stay are slightly improved with the laparoscopic approach. Laparoscopic resection of rectal cancer is not

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Updated Systematic Review and Meta-Analysis of Randomized Clinical Trials on the Role of Mechanical Bowel Preparation Before Colorectal Surgery

Cited by 308 publications

References 23 publications

Enhanced recovery after surgery (ERAS) protocols: Time to change practice?

Enhanced recovery after surgery (ERAS) protocols: Time to change practice?

Surgical management of colorectal cancer: A review of the literature

Laparoscopic extraperitoneal rectal cancer surgery: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES)

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