Usefulness of Preoperative Mechanical Bowel Preparation in Patients with Colon Cancer who Undergo Elective Surgery: A Prospective Randomized Trial Using Oral Antibiotics

Abstract

Background: To prevent surgical site infection (SSI) in colorectal surgery, the combination of mechanical bowel preparation (MBP), oral antibiotic bowel preparation (OABP), and the intravenous antibiotics have been proposed as standard treatment. We conducted an RCT comparing the incidence of SSI between MBP + OABP and OABP alone after receiving a single dose of intravenous antibiotics. Methods: The study group comprised 254 patients who underwent elective surgery for colon cancer. Patients were randomly assigned to receive MBP + OABP and intravenous antibiotics (MBP + OABP group) or to receive OABP and intravenous antibiotics (OABP alone group). Results: Overall, 125 patients in MBP + OABP group and 126 patients in OABP alone group were eligible. Incisional SSI occurred in 3 patients (2.4%) in MBP + OABP group, and 8 patients (6.3%) in the OABP-alone group. Organ/space SSI developed in 0 patients (0%) and in 4 patients (3.2%) in each group respectively. The OABP-alone group was thus not shown to be noninferior to the MBP + OABP group in the incidences of incisional SSI or organ/ space SSI. Other infectious complications developed in 7 pa-tients (5.6%) and in 6 patients (4.8%) in each group, indicating the non-inferiority of OABP alone to MBP + OABP. Conclusions: MBP combined with oral antibiotics and intravenous antibiotics remains standard in elective colon cancer surgery.

Mechanical plus oral bowel preparation with paromomycin and metronidazole reduces infectious complications in elective colorectal surgery: a matched case-control study

“…In general, different antibiotic regimens are used in accordance with local availability of drugs and possible side effects. Most of the studies report the use of either an aminoglycoside (i.e., neomycine [16][17][18], kanamycine [19], streptomycin [20], gentamicine [21]) or a fluoroquinolone (levofloxacine [1] or ciprofloxacine [15]) plus metronidazole. Additionally, in all present studies, single-shot antibiotics were used preoperatively, mostly consisting of an IV application of a secondgeneration cephalosporine plus metronidazole intravenously.…”

Influence of combined mechanical-chemical versus mechanical bowel preparation on anastomotic leak and surgical site infections after elective resection of left colon cancer

“…23 Similar decrease of infectious complications was reported by several other studies. 11,24,25 An added advantage of MBP and OABx was the remarkable cost saving in association with diminished incidence of surgical site infection. 26 We also found that bowel preparation in MBP and OABx was associated with reduction of postoperative complications, including mortality, and concomitant shortening of the length of hospital stay.…”

“…10 In sharp contrast, other studies have demonstrated clear advantage of MBP in reducing both AL and SSI. 11 It appears that a key factor explaining the divergent results from the currently available literature is the lack of consideration of the influence of oral antibiotics (OABx) on adequacy of preoperative bowel preparation. 12 In this context, MBP is supposed to enhance the uptake of OABx by colonic mucosa.…”

The use of oral antibiotics and mechanical bowel preparation in elective colorectal resection for the reduction of surgical site infection

“…The need for an RCT to determine this has long been discussed , because data on OAB alone are contradictory. Different reports show that the use of OAB alone is worse than , equivalent to or better than the MOAB combination in reduction of SSI. The problems are a lack of RCTs that focus on OAB alone in the absence of MBP, small numbers in the OAB alone groups and selection bias in the cohort studies.…”

“…The need for an RCT to determine this has long been discussed [17, 84,85], because data on OAB alone are contradictory. Different reports show that the use of OAB alone is worse than [24,25,27,[29][30][31]43,86], equivalent to [22,26,28,42,87] The problems are a lack of RCTs that focus on OAB alone in the absence of MBP, small numbers in the OAB alone groups and selection bias in the cohort studies. In the largest and most recent meta-analysis [42], SSI rates were compared between patients having MOAB and OAB alone.…”