Influence of rectal washout on bacterial counts in the rectal stump

Abstract

Forty-three patients undergoing a restorative colorectal resection were randomized to have their rectal stump washed out with either 0.9 per cent saline, 2.5 per cent povidone-iodine or 0.3 per cent sodium hypochlorite. The bacterial counts before and after washout for Escherichia coli and Bacteroides fragilis were compared using the Mann-Whitney U test. There was no significant difference in the counts for E. coli before and after washout with saline (log 9.7-log 9.7 organisms/ml) and saline had no influence on the counts of B. fragilis (log 7.9-log 6.5 organisms/ml). Hypochlorite was associated with a significant reduction in E. coli counts (log 6.1-log 1.1 organisms/ml, P less than 0.005) and the counts of B. fragilis (log 8.1-log 0.0 organisms/ml, P less than 0.005). The counts of B. fragilis were significantly reduced by povidone-iodine (log 8.1-log 1.1 organisms/ml, P less than 0.005) but there was no significant reduction in counts of E. coli (log 5.6-log 5.3 organisms/ml). The data suggest that sodium hypochlorite is better than povidone-iodine or saline as a rectal washout for colorectal anastomosis.

Senna vs Polyethylene Glycol for Mechanical Preparation the Evening Before Elective Colonic or Rectal Resection

“…As with 90 mL of sodium phosphate, 34 senna can be considered the standard for elective colonic or rectal resection. Further progress can be expected when senna vs sodium phosphate, various combinations of oral and systemic antibiotics, and other antiseptic enemas (povidone vs hypochlorite) 36…”

Rectosigmoid stump washout as an alternative to permanent mucous fistula in patients undergoing subtotal colectomy for ulcerative colitis in emergency settings

“…A recent review from the Mayo Clinic was sceptical about PVI usefulness in colon surgery, nevertheless the authors concluded that in the acute setting peritoneal or wound irrigation with PVI may be useful in dirty or contaminated operations [8]. It has been suggested that Sodium Hypochlorite is more active on E. coli than PVI [9], but its use should be avoided as it is associated with higher rate of complications [7-10]. However, also colonic irrigation with PVI has some local and systemic effects, as from an animal model: 30 minutes exposure to 5 percent PVI caused severe colonic mucosal injury, with detachment of the epithelial cell layer.…”

Natural orifice translumenal endoscopic surgery (NOTES) applied totally to sigmoidectomy: an original technique with survival in a porcine model

“…Likely, the margin of safety also could be enhanced further by specific means of preoperative antibiotic bowel decontamination [13][14][15]. However, the main intellectual innovation in our technique lies in its obviation of the daunting requirement to close the transcolonic passageway to the pelvis because the fecal flora, combined with the thin wall of the viscus, affords zero tolerance of any flaw in a prospective seal.…”