Laparoscopic colon resection: To prep or not to prep? Analysis of 1535 patients

Allaix, Marco Ettore; Arolfo, Simone; Degiuli, Maurizio; Giraudo, G.; Volpatto, Silvio; Morino, Mario

doi:10.1007/s00464-015-4515-0

Cited by 20 publications

(16 citation statements)

References 29 publications

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“…We found no difference in the anastomotic leakage rate between the MBP and no‐MBP groups. Our findings were consistent with previous studies in which researchers failed to prove the benefit of MBP in reducing infectious complications and anastomotic leakages in both open and laparoscopic colectomy . Coupled with previous studies, our findings indicated that MBP can be omitted before laparoscopic colectomy.…”

Section: Discussionsupporting

confidence: 92%

Randomized controlled trial of mechanical bowel preparation for laparoscopy‐assisted colectomy

Mai‐Phan¹,

Nguyen

et al. 2018

Asian J Endoscop Surgery

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Introduction The benefit of mechanical bowel preparation (MBP) before open colon surgery has been debated over the last decade. The aim of this randomized controlled trial was to evaluate the effect of MBP on the outcome of patients who underwent elective laparoscopic colectomy. Methods Patients who were scheduled to undergo elective laparoscopic colon resection with primary anastomosis were randomly allocated to a preoperative MBP group (either two bottles of sodium phosphate or 2‐L polyethylene glycol) or a no‐MBP group. Anastomotic leakage and other complications such as surgical‐site infection and extra‐abdominal complications were recorded postoperatively. Results In this study, 122 patients were recruited and randomly allocated to the MBP group (n = 62) or the no‐MBP group (n = 60). Demographic and clinical characteristics were not significantly different between the two groups. The rate of abdominal complications, including anastomotic leak and surgical‐site infection, was 16.2% in the MBP group and 18.3% in the no‐MBP group (P = 0.747). Anastomotic leakage occurred in four patients (6.5%) in the MBP group and in two patients (3.3%) in no‐MBP group (P = 0.680). About 29% of patients in the MBP group still had either liquid or solid content in the bowel. No significant difference was found between the length of hospital stay in the MBP group and the no‐MBP group (9.0 ± 2.9 vs 8.4 ± 1.9 days, P = 0.180). Conclusions Elective laparoscopic colectomy without MBP is safe and offers acceptable postoperative morbidity.

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Section: Discussionsupporting

confidence: 92%

Randomized controlled trial of mechanical bowel preparation for laparoscopy‐assisted colectomy

Mai‐Phan¹,

Nguyen

et al. 2018

Asian J Endoscop Surgery

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“…When data obtained from 21 randomised controlled trials[ 37 , 40 , 43 , 45 - 61 , 64 , 65 ] alone with a total of 5971 patients were included (Supplementary figure 2A), the use of MBP vs no MBP did not impact upon the incidence of SSI (OR = 1.16, 95%CI: 0.96 to 1.39, P = 0.12), nor when MBP vs single rectal enema[ 37 , 45 , 47 , 51 , 53 ] or MBP vs absolutely no preparation[ 40 , 43 , 46 , 48 - 50 , 52 , 54 - 61 , 64 , 65 ] were considered. When just observational studies were included[ 29 , 66 - 70 , 72 - 75 , 77 ] (11 studies, 13809 patients; Supplementary figure 2B), patients who received MBP had a significantly reduced incidence of SSI than those who did not receive MBP (OR = 0.64, 95%CI: 0.55 to 0.75, P < 0.0001), with similar results seen in those who received MBP vs absolutely no MBP[ 29 , 68 , 70 , 73 , 75 ], although no difference was seen between those who received full MBP vs a single rectal enema[ 66 , 67 , 69 , 72 , 74 , 77 ].…”

Section: Resultsmentioning

confidence: 80%

“…When MBP was compared with no MBP (including no preparation at all and those who underwent a single rectal enema), there was no difference in the incidence of anastomotic leak (OR = 0.90, 95%CI: 0.74 to 1.10, P = 0.32). When MBP vs absolutely no MBP was analysed[ 29 , 40 , 46 , 48 - 50 , 52 , 54 - 65 , 68 , 70 , 71 , 73 ], this made no difference to anastomotic leak rates (OR 0.94, 95% CI 0.70 to 1.25, P = 0.67), nor when MBP was compared with a single rectal enema[ 37 , 45 , 47 , 51 , 53 , 66 , 67 , 69 , 72 , 74 , 76 , 77 ] (OR = 0.92, 95%CI: 0.70 to 1.20, P = 0.52).…”

Section: Resultsmentioning

confidence: 99%

“…When randomised controlled trials alone were included in the analysis[ 37 , 40 , 45 - 65 ] (Supplementary figure 1A), the use of MBP vs no MBP did not affect the incidence of anastomotic leak (OR = 1.02, 95%CI: 0.75 to 1.40, P = 0.90), nor when MBP vs absolutely no MBP[ 40 , 46 , 48 - 50 , 52 , 54 - 65 ] or MBP vs single rectal enema[ 37 , 45 , 47 , 51 , 53 ]were considered. When observational studies alone were analysed[ 66 - 73 , 76 , 77 ] (Supplementary figure 1B), the use of MBP vs no MBP did significantly affect the incidence of anastomotic leak (OR = 0.76, 95%CI: 0.63 to 0.91, P = 0.003), although this was not significant when MBP vs single rectal enema[ 66 , 67 , 69 , 72 , 74 , 76 , 77 ] and MBP vs absolutely no MBP[ 29 , 68 , 70 , 71 , 73 ] were considered separately.…”

Section: Resultsmentioning

confidence: 99%

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Impact of mechanical bowel preparation in elective colorectal surgery: A meta-analysis

Rollins¹,

Javanmard‐Emamghissi²,

Lobo³

2018

WJG

141

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AIMTo analyse the effect of mechanical bowel preparation vs no mechanical bowel preparation on outcome in patients undergoing elective colorectal surgery.METHODSMeta-analysis of randomised controlled trials and observational studies comparing adult patients receiving mechanical bowel preparation with those receiving no mechanical bowel preparation, subdivided into those receiving a single rectal enema and those who received no preparation at all prior to elective colorectal surgery.RESULTSA total of 36 studies (23 randomised controlled trials and 13 observational studies) including 21568 patients undergoing elective colorectal surgery were included. When all studies were considered, mechanical bowel preparation was not associated with any significant difference in anastomotic leak rates (OR = 0.90, 95%CI: 0.74 to 1.10, P = 0.32), surgical site infection (OR = 0.99, 95%CI: 0.80 to 1.24, P = 0.96), intra-abdominal collection (OR = 0.86, 95%CI: 0.63 to 1.17, P = 0.34), mortality (OR = 0.85, 95%CI: 0.57 to 1.27, P = 0.43), reoperation (OR = 0.91, 95%CI: 0.75 to 1.12, P = 0.38) or hospital length of stay (overall mean difference 0.11 d, 95%CI: -0.51 to 0.73, P = 0.72), when compared with no mechanical bowel preparation, nor when evidence from just randomized controlled trials was analysed. A sub-analysis of mechanical bowel preparation vs absolutely no preparation or a single rectal enema similarly revealed no differences in clinical outcome measures.CONCLUSIONIn the most comprehensive meta-analysis of mechanical bowel preparation in elective colorectal surgery to date, this study has suggested that the use of mechanical bowel preparation does not affect the incidence of postoperative complications when compared with no preparation. Hence, mechanical bowel preparation should not be administered routinely prior to elective colorectal surgery.

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“…The lack of benefit for MBP has been shown in proctectomy [32,33], low anterior resection [34], surgery for diverticulitis [35] and cancer [36] as well as in laparoscopic resections [37]. A clinical study on gastrointestinal motility also showed that there was no difference in the postoperative recovery course for MBP versus no MBP, but in fact MBP was associated with slower colonic excretion of radiopaque markers [38].…”

Section: Mbp Alonementioning

confidence: 96%

Benefit of mechanical bowel preparation prior to elective colorectal surgery: current insights

Murray

Kiran

2016

Langenbecks Arch Surg

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Laparoscopic colon resection: To prep or not to prep? Analysis of 1535 patients

Abstract: The use of preoperative MBP does not seem to be associated with lower incidence of intra-abdominal septic complications after LCR.

Cited by 20 publications

References 29 publications

Randomized controlled trial of mechanical bowel preparation for laparoscopy‐assisted colectomy

Randomized controlled trial of mechanical bowel preparation for laparoscopy‐assisted colectomy

Impact of mechanical bowel preparation in elective colorectal surgery: A meta-analysis

Benefit of mechanical bowel preparation prior to elective colorectal surgery: current insights

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