Mechanical bowel preparation and antibiotic prophylaxis in colorectal surgery: use by and opinions of Spanish surgeons

Abstract

There is general agreement on AP. MBP remained a common practice among Spanish colorectal surgeons except for right colonic resection. Surgeons with more case load and specialization used it significantly less.

Mechanical bowel preparation and antimicrobial prophylaxis in elective colorectal surgery in Switzerland—a survey

“…Our results partially support the findings of other studies, which have shown that surgeons with greater activity in colorectal surgery used less MBP [11], that MBP in right colonic resection is used significantly less frequently than in left colonic or rectal resections [11], and that there is a discrepancy both between the subjectively rated usefulness of MBP and the effective use of MBP [12] and between the current evidence and the preoperative bowel preparation practices among surgeons globally [11][12][13]15]. The reason for the latter is largely unknown and might be caused by aesthetic and practical factors, especially in laparoscopic surgery.…”

“…The rate of use of antimicrobial prophylaxis in the current study (100%) compared favorably with previously published data [11,12]; in contrast, the parenteral route of administration of antibiotics in colorectal surgery in Switzerland was preferred (100%), whereas Spanish and US surgeons use orally administered antibiotics as well in 13.8% and 86% of patients, respectively, or in a combination of both. Parenteral administration yielded similar results compared with a combination of parenteral and oral prophylaxis [10].…”

“…Other authors have shown that MBP is associated with spillage of bowel contents during surgery, which may increase wound infections [19], produce an inflammatory response of the bowel wall which might cause on a greater amount of anastomotic leakage [9], and that MBP is distressing for the patient [20]. Surgeons in Switzerland who have not abandoned MBP yet used sodium phosphate less often and PEG more often than did others (27% and 63% vs. 63.5% and 36.5% used by Spanish surgeons [11], and 47% and 32% used by members of the American Society of Colon and Rectal Surgeons [12]), although sodium phosphate seems to be more effective than PEG in cleansing and more favorable in terms of adverse effects [21]. In the recent data accumulation against MBP in colonic resections, the query about the ideal agent in MBP as well as the role of MBP in rectal surgeries still persists [16].…”

“…Others considered the absence of a strong recommendation for abandoning MBP in the guidelines of surgical societies as being reflected in surgeons' continued practice of MBP irrespective of geographical site [16]. The comparison of the MBP rates with other studies among colorectal surgeons in Western countries showed that surgeons in Switzerland used MBP less often than do others [11][12][13]17] but astonishingly still to a great extent even when there is little evidence to support its use. Even in Switzerland, where the quality of medicine is first class, the surgeons do not read the literature carefully enough or are reluctant to change their practice despite the scientific evidence.…”

“…A recommendation to abandon MBP as a routine has not found a place in the guidelines of various surgical societies, as yet. A recent survey of Spanish colorectal surgeons showed a frequency of routinely used MBP of 86% for laparoscopic surgery and of 87% for open colorectal surgery [11]. Among 515 US colon and rectal surgeons, the rate of antimicrobial prophylaxis use was 98%, and the rate of MBP use was 99% [12].…”