Prevention of anastomotic leak in rectal cancer surgery with local antibiotic decontamination: a prospective, randomized, double-blind, placebo-controlled single center trial

Schardey, H. M.; Wirth, Ulrike; Strauß, T.; Kasparek, Michael S.; Schneider, Dietmar; Jauch, Karl‐Walter

doi:10.1007/s00384-020-03544-8

Cited by 34 publications

(51 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The results did not show any significant difference in regard to SSIs, AL or reoperation rate between the two groups [143] . In 2020, the late report of an RCT conducted in 1999–2004 was published [144] . In this RCT, the use of MBP + OABs vs MBP was investigated in patients undergoing rectal surgery.…”

Section: Methodsmentioning

confidence: 99%

The gut microbiota and colorectal surgery outcomes: facts or hype? A narrative review

et al. 2021

View full text Add to dashboard Cite

Background The gut microbiota (GM) has been proposed as one of the main determinants of colorectal surgery complications and theorized as the “missing factor” that could explain still poorly understood complications. Herein, we investigate this theory and report the current evidence on the role of the GM in colorectal surgery. Methods We first present the findings associating the role of the GM with the physiological response to surgery. Second, the change in GM composition during and after surgery and its association with colorectal surgery complications (ileus, adhesions, surgical-site infections, anastomotic leak, and diversion colitis) are reviewed. Finally, we present the findings linking GM science to the application of the enhanced recovery after surgery (ERAS) protocol, for the use of oral antibiotics with mechanical bowel preparation and for the administration of probiotics/synbiotics. Results According to preclinical and translational evidence, the GM is capable of influencing colorectal surgery outcomes. Clinical evidence supports the application of an ERAS protocol and the preoperative administration of multistrain probiotics/synbiotics. GM manipulation with oral antibiotics with mechanical bowel preparation still has uncertain benefits in right-sided colic resection but is very promising for left-sided colic resection. Conclusions The GM may be a determinant of colorectal surgery outcomes. There is an emerging need to implement translational research on the topic. Future clinical studies should clarify the composition of preoperative and postoperative GM and the impact of the GM on different colorectal surgery complications and should assess the validity of GM-targeted measures in effectively reducing complications for all colorectal surgery locations.

show abstract

Section: Methodsmentioning

confidence: 99%

The gut microbiota and colorectal surgery outcomes: facts or hype? A narrative review

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Reduction of anastomotic leakage (AL) has been considered a primary end point in several studies that evaluated preoperative bowel decontamination. Schardey et al [37] terminated their study after an interim analysis because of a significant reduction in AL in rectal resections. They used a very broad combination of topical antibiotic agents comprising tobramycin, vancomycin, polymyxin B, and amphotericin B with existing data provides diverse recommendations with regard to AL reduction which further stresses the necessity of studies on the best antibiotic regime for perioperative bowel preparation.…”

Section: Discussionmentioning

confidence: 99%

Mechanical plus oral bowel preparation with paromomycin and metronidazole reduces infectious complications in elective colorectal surgery: a matched case-control study

Lübbert

Chaberny

Gockel

et al. 2021

Int J Colorectal Dis

View full text Add to dashboard Cite

Purpose Infectious complications are as high as 30% in elective colorectal surgery. In recent years, several studies have discussed the topic of preoperative bowel decontamination prior to colorectal surgery in order to reduce postoperative infectious complications and have found significant effects of oral antibiotic administration with a large variety of drugs used. No study has evaluated the combination of oral paromomycin and metronidazole in this context. Methods We performed a prospective single-center study with a matched-pair retrospective cohort to evaluate postoperative infectious complications (superficial site infections, organ space abscess, anastomotic leakage) in elective colorectal surgery. Patients A total of 120 patients were available for study inclusion; 101 gave informed consent and were included. A total of 92 patients were matched and subsequently analyzed. We could show a reduction in overall infectious complications in the intervention group (15.2% vs 30.8%, p = 0.018; odds ratio 0.333, 95% CI 0.142–0.784) as well as a reduction in superficial surgical site infections (8.7 vs 19.6%, p = 0.041, OR 0.333, 95% CI 0.121–0.917). The frequency of the other infectious complications such as intraabdominal abscesses and anastomotic leakage showed a tendency towards decreased frequencies in the intervention group (OR 0.714, 95% CI 0.235–2.169 and OR 0.571; 95% CI 0.167–1.952, respectively). Finally, the oral antibiotic administration led to an almost significantly reduced length of stay (12.24 days vs 15.25 days; p = 0.057). Conclusions Oral paromomycine and metronidazole with intravenous ertapenem effectively reduce infectious complications in elective colorectal surgery. Trial registration The study was registered at Clinicaltrials.gov (NCT03759886) December 17, 2018

show abstract

“…In elective colorectal surgery, the concept of “selective decontamination of the digestive tract” (SDD) with use of topical antibiotics is current subject of debate among colorectal surgeons [ 14 – 17 ]. The role of bacteria in the development of anastomotic leakage (AL) and surgical site infections (SSIs) has been clarified over the past years, and the use of oral antibiotic bowel decontamination (OABD) [ 18 – 21 ] and combined OABD and mechanical bowel preparation (MBP) is widely recommended in elective colorectal surgery [ 14 , 15 , 22 – 24 ]. Despite that recommendation, especially in Europe, there is no widespread use of OABD regimens but an ongoing debate of its efficacy for prevention of AL and decreasing SSI or infectious complications in general [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…Despite that recommendation, especially in Europe, there is no widespread use of OABD regimens but an ongoing debate of its efficacy for prevention of AL and decreasing SSI or infectious complications in general [ 15 ]. Data from recent published randomized controlled trials are inconsistent due to essential differences in OABD regimens [ 18 , 25 – 27 ].…”

Section: Introductionmentioning

confidence: 99%

“…Based on the modified SDD regimen introduced by Schardey et al in gastric and rectal cancer surgery [ 18 , 28 ], the perioperative OABD has been used in colorectal surgery at the Surgical Department of Agatharied Hospital (AH) since 1999 [ 17 ] and was successfully introduced at the Surgical Department of Neumarkt Hospital (NH) as well.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Oral antibiotic bowel decontamination in open and laparoscopic sigmoid resections for diverticular disease

Wirth

Schardey

Ahnen

et al. 2021

Int J Colorectal Dis

Self Cite

View full text Add to dashboard Cite

Purpose There is an ongoing debate on whether or not to use oral antibiotic bowel decontamination in colorectal surgery, despite the numerous different regimens in terms of antibiotic substances and duration of application. As we routinely use oral antibiotic bowel decontamination (selective decontamination of the digestive tract (SDD) regimen and SDD regimen plus vancomycin since 2016) in surgery for diverticular disease, our aim was to retrospectively analyze the perioperative outcome in two independent centers. Methods Data from two centers with a routine use of oral antibiotic bowel decontamination for up to 20 years of experience were analyzed for the perioperative outcome of 384 patients undergoing surgery for diverticular disease. Results Overall morbidity was 12.8%, overall mortality was 0.3%, the overall rate of anastomotic leakage (AL) was 1.0%, and surgical site infections (SSIs) were 5.5% and 7.8% of all infectious complications including urinary tract infections and pneumonia. No serious adverse events were related to use of oral antibiotic bowel decontamination. Most of the patients (93.8%) completed the perioperative regimen. Additional use of vancomycin to the SDD regimen did not show a further reduction of infectious complications, including SSI and AL. Conclusion Oral antibiotic decontamination appears to be safe and effective with low rates of AL and infectious complications in surgery for diverticular disease.

show abstract

Prevention of anastomotic leak in rectal cancer surgery with local antibiotic decontamination: a prospective, randomized, double-blind, placebo-controlled single center trial

Cited by 34 publications

References 45 publications

The gut microbiota and colorectal surgery outcomes: facts or hype? A narrative review

The gut microbiota and colorectal surgery outcomes: facts or hype? A narrative review

Mechanical plus oral bowel preparation with paromomycin and metronidazole reduces infectious complications in elective colorectal surgery: a matched case-control study

Oral antibiotic bowel decontamination in open and laparoscopic sigmoid resections for diverticular disease

Contact Info

Product

Resources

About