Mechanical Bowel Preparation for Elective Colorectal Surgery with Primary Intraperitoneal Anastomosis by a Single Surgeon: Interim Analysis of a Prospective Single-Blinded Randomized Trial

Abstract

We report an interim analysis of a prospective single-blinded randomized trial designed to investigate whether preoperative mechanical bowel preparation influences the rate of surgical-site infection and anastomotic failure after elective colorectal surgery with primary intraperitoneal anastomosis performed by a single surgeon. Patients scheduled to undergo an elective colorectal procedure with a primary intraperitoneal anastomosis were randomized to receive either oral polyethylene glycol lavage solution and enemas (group A) or no preparation (group B). Surgical-site infection and anastomotic failure were investigated. Of 97 patients included, 48 were assigned to group A and 49 to group B. Twelve (12.4%) developed wound infections, six in each group (12.5 vs. 12.2%; NS). Intra-abdominal sepsis was only seen in group A (n = 3, 6.3%). Anastomotic failure occurred in four patients in group A (8.3%) vs. two patients in group B (4.1%) (NS). The overall complication rate in group A was 27.1%, vs. 16.3% in group B. The number needed to harm was 9.3. Our interim analysis of a prospective single-blinded randomized trial suggests that a surgeon may have the same or even worse outcomes when mechanical bowel preparation is routinely used for colorectal surgery with primary intraperitoneal anastomosis.

Single-blinded Randomized Trial of Mechanical Bowel Preparation for Colon Surgery with Primary Intraperitoneal Anastomosis

“…The approach to the abdominal cavity was standardized as previously described. 17 Both ends of the intestinal segment were sectioned with staplers (GIA, Tyco Healthcare) to avoid the spillage of feces. Anastomoses were hand-sewn or stapled according to the preference of the surgeon.…”

Mechanical Bowel Preparation in Intestinal Surgery: A Meta-Analysis and Review of the Literature

“…[26][27][28][29] Since then, several trials have been performed. [30][31][32][33][34][35][36][37] All studies are slightly different in their methodology, with some studies including patients who also underwent procedures in which intestinal continuity was not restored, and others including procedures in both the right and left colon. Anastomotic leak rates for all studies are summarized in Table 1.…”

Mechanical Bowel Preparation for Elective Colorectal Surgery: Is it Enough?

“…[2][3][4][5][6][7][8][9][10][11][12][13] The overall analysis of the main outcome measures shows that no parameter reaches the statistical significance between MBP vs. non-MBP patients ( Table 1). The only exception is represented by the occurrence of cardiac events (acute myocardial infarctions, atrial fibrillations, heart failures, angina pectoris) that seem decreased in the non-MBP group ( Table 1).…”