Is mechanical bowel preparation really necessary for elective left sided colon and rectal surgery?

Memon, Muhammed Ashraf; Devine, J.; Freeney, J.; From, Steven G.

doi:10.1007/s003840050110

Cited by 33 publications

(26 citation statements)

References 23 publications

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“…The policy in our hospital has so far been to use a covering stoma for left-sided traumatic perforations with diffuse fecal peritonitis. However, owing to increased literature of primary anastomosis without a covering stoma [10, 11, 12, 13]and omitting bowel preparation in elective bowel surgery [14, 15, 16, 17], we have changed our policy to favor primary anastomosis without a covering stoma in colonic obstruction and simple perforations with localized peritonitis.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Temporary Stomas

et al. 2002

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Purpose: The purpose of this study was to examine the outcome of patients to whom a temporary stoma was constructed in our institution. Method: The outcome of patients operated on over an 8-year period was prospectively examined. Special attention was given to the influence of age on complications and closure of stomas. Results: Between 1989 and 1996, a total of 349 intestinal stomas were constructed in 342 patients. In 141 of these patients, the stoma could be considered as temporary. The 30-day mortality rate was 7%. The overall complication rate was 50%. Pure stoma-related complications were observed in 12% of the patients. The final closure rate of temporary stomas was 67%. The closure rate was significantly higher if the temporary stomas were of the double-barrel type. There was no significant difference in the closure rate between patients with benign and malignant diseases, but the rate decreased significantly in age groups over 70 years. Conclusions: Forty percent of stomas constructed are considered as temporary, but only two-thirds of temporary stomas are closed subsequently. Especially end stomas tend to become permanent in patients over 70 years of age, although the morbidity rates of stoma closure do not differ from those of younger patients.

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Section: Discussionmentioning

confidence: 99%

Outcome of Temporary Stomas

et al. 2002

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“…They evolved without significant complications and in a low complication rate. Thus, it should be standardize elective colorectal operation without bowel preparation 2,8,9 .…”

Section: Discussionmentioning

confidence: 99%

“…Similarly Parré Ambroise (1510-1590) in his tests showed a high mortality rate as a result of infectious complications in the post-operative period. Only with the advent of antibiotics there was a reduction in morbidity and mortality of these operations 6,8,11 . Over the last few decades, several authors have shown clinical experience of long-term removal of feces from the colon associated with decreased morbidity and mortality in patients undergoing the operation of the colon.…”

Section: Introductionmentioning

confidence: 99%

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Preparo mecânico dos cólons é uma rotina necessária?

Lins-Neto

Leão

Alves

et al. 2012

ABCD, arq. bras. cir. dig.

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HEADINGS -Colorectal surgery. Colon. Surgical wound infection. RESUMO -Racional -O valor do preparo de cólon prévio nas operações colorretaiscontinua discutível, visto que devido à tradição da rotina do preparo poucos estudos têm sido realizados para sustentação da operação segura sem o preparo mecânico. ABCDDV/831ABSTRACT -Background -The value of the preparation of the colon prior colorectal surgery remains debatable. Since installed as traditional the use of this routine, few studies have been conducted to support the safety of surgeries done without mechanical bowel preparation. Aim -To determine if there is a correlation between postoperative complications and no use of mechanical bowel preparation in operated patients. Methods -Was conducted a prospective study in patients undergoing coloproctology abdominal surgery without prior bowel preparation. Results -The sample consisted of 126 patients, 57 men and 69 women. The average age was 54 years (19 to 89). Among patients who had comorbidities (43 patients -34,12%), 30 (23,80%) had arterial hypertension. Antibiotic prophylaxis was used in 89,70%. Among the patients, 14,28% had complications: eight (6,34%) wound infection, six (4,76%) anastomotic dehiscence and four (3,17%) fistula. Conclusion -The pre-operative mechanical bowel preparation is not essential in the routine of colorectal surgeries.

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“…Studies have been conducted and published along the time worldwide. And today, the reaction of the medical class, based on statistical results, has another conotation [43][44][45][46][47][48] . Studies have also changed and more careful randomization has been a constant concern of the authors, which improves the study quality 49 .…”

Section: Description Of Trialsmentioning

confidence: 99%

Preoperative mechanical bowel preparation in elective colorectal surgery: an update of systematic review of the literature and meta-analysis

Güenaga¹,

Matos²,

Wille‐Jørgensen³

2012

J. Coloproctol. (Rio J.)

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Güenaga KF, Matos D, Wille-Jørgensen P. Preoperative mechanical bowel preparation in elective colorectal surgery. An update of systematic review of the literature and meta-analysis. J Coloproctol, 2012;32(1): 7-17. AbstrACt:The belief that mechanical bowel preparation is related to the reduction of complications in elective colorectal surgery is based on observational studies and expert opinion. This question led the authors to a systematic literature review, with the completion of meta-analysis, followed by three updates. Method: The sources of information were EMBASE, LILACS, MEDLINE, IBECS, the Cochrane Controlled Trials Register and letters to the authors. The studies were included according to the randomization criteria. The studied variables were: anastomotic dehiscence, mortality and operatory wound infection. The analysis was divided into two comparisons: one group with mechanical preparation (Group A) compared with a group without preparation (Group B) (Comparison I) and a group submitted to rectal enema (Comparison II). results: We analyzed 5,805 patients in 20 clinical trials. In comparison I, anastomotic leak occurred in 4.4% (101/2,275 patients) in Group A and 4.5% (103/2,258 patients) in Group B. In comparison II, anastomotic leak occurred in 4.4% (27/601 patients) in Group A and 3.4% (21/609 patients) in Group B. Conclusion: Despite the inclusion of more studies, evidences found in studies did not show any benefit obtained from the use of preoperative mechanical bowel preparation or rectal cleansing enemas in elective colorectal surgery.Keywords: colorectal surgery; review; meta-analysis; postoperative complications; anastomotic leak. resuMO: A crença de que o preparo mecânico do cólon está relacionado à diminuição de complicações na cirurgia colorretal eletiva é baseada em estudos observacionais e opinião de especialistas. Seu questionamento motivou os autores na busca sistemática da literatura, com a realização de meta-análise, seguida de três atualizações. Método: Fontes de informação foram EMBASE, LILACS, MEDLINE, IBECS, Registros de Ensaios Clínicos Casualizados da Colaboração Cochrane e cartas para os autores. Os estudos foram incluídos de acordo com os critérios de casualização. Os desfechos clínicos estudados foram: deiscência anastomótica, mortalidade e infecção da ferida operatória. A análise dos grupos foi dividida em duas comparações: comparação I, grupo submetido a preparo mecânico do cólon (Grupo A) comparado ao grupo sem preparo (Grupo B); comparação II, Grupo A, submetido a preparo do cólon e Grupo B, realizado apenas enema retal. resultados: Foram analisados 5.805 doentes em 20 ensaios clínicos. Na comparação I, deiscência anastomótica ocorreu em 4,4% (101/2.275 doentes) no Grupo A e 4,5% (103/2.258 doentes) no Grupo B. Na comparação II, deiscência anastomótica ocorreu em 4,4% (27/601 doentes) no Grupo A e 3,4% (21/609 doentes) no Grupo B. Conclusão: Apesar da inclusão de mais estudos, as evidências encontradas não demonstraram benefício no uso do preparo mecânico pré-operatório d...

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Is mechanical bowel preparation really necessary for elective left sided colon and rectal surgery?

Cited by 33 publications

References 23 publications

Outcome of Temporary Stomas

Outcome of Temporary Stomas

Preparo mecânico dos cólons é uma rotina necessária?

Preoperative mechanical bowel preparation in elective colorectal surgery: an update of systematic review of the literature and meta-analysis

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