Outcome of no oral antibiotic prophylaxis and bowel preparation in Crohn’s diseases surgery

Abstract

SummaryBackgroundRecent studies support the use of mechanical bowel preparation and/or oral antibiotic prophylaxis in patients operated on for Crohn’s disease (CD); however, data are scarce, especially for laparoscopic surgery. Therefore, this study was carried out to investigate the effect of laparoscopic surgery on complication rates in patients not undergoing standardized bowel preparation but single shot antibiotics.MethodsIn this study 255 consecutive patients who underwent a laparoscopic intestinal resection for CD at a tertiary referral center between 1997 and 2014 were retrospectively analyzed. Superficial surgical site infections (SSI), organ/space infections and ileus were recorded and grouped according to the type of resection (colorectal vs. small intestine ± ileocecal).ResultsThe baseline characteristics of the groups were comparable. Colorectal resections showed a significantly increased risk of organ/space infection (4.6% in small intestine ± ileocecal vs. 14.3% in colorectal resections p = 0.039). The superficial SSI rate was low in both groups (1.8% in small intestine ± ileocecal resection vs. 0% in colorectal resections, p = 1.000). Univariate binary logistic regression analysis revealed a statistically significant influence of duration of surgery (p = 0.001) and type of resection (p = 0.031) on organ/space infection. In multivariate analysis, only duration of surgery (OR 1.111, 95% CI 1.026–1.203 for every 10 min, p = 0.009) remained significant for postoperative organ/space infections.ConclusionsSingle-shot antibiotic therapy without bowel preparation is safe in patients undergoing minimally invasive surgery and was associated with a low number of complications; however, organ/space infections were more common if colorectal resections were performed. Therefore, combined bowel preparation might be beneficial when the (sigmoid) colon or rectum are involved.

ECCO Topical Review: Roadmap to Optimal Peri-Operative Care in IBD

“…A recent study (60) concluded that the rate of septic intra-abdominal complications was significantly reduced by A c c e p t e d M a n u s c r i p t pre-operative mechanical bowel preparation combined with pre-operative oral antibiotics (paromomycin and metronidazole) on the day before surgery. Unger et al (61) carried out a study that included 255 patients with CD who underwent laparoscopic intestinal resection with or without mechanical bowel preparation and/or oral antibiotic prophylaxis and found that, while a single dose antibiotic alone without bowel preparation was associated with a low number of complications in patients undergoing small bowel resections, organ/space infections were more common if colorectal resections were performed without bowel preparation. These results suggest that combined bowel preparation and oral antibiotics might be beneficial when the colon is involved in the resection.…”

Bedeutung der Chirurgie bei M. Crohn

“…Bei fistulierender Erkrankung sollte eine chirurgische Therapie ebenfalls zu einem frühen Zeitpunkt erfolgen [1,2]. Wann immer möglich, sollte ein laparoskopischer Zugang auch bei Rezidiven erfolgen, da hier die Ergebnisse vergleichbar mit offenen Operationen sind, das operative Trauma jedoch minimiert wird [6][7][8].…”