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

Abstract

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.

Updates of Risk Factors for Anastomotic Leakage after Colorectal Surgery

“…In a meta-analysis by Rollins et al including 21,568 patients undergoing elective colorectal surgery, the authors concluded that the use of MBP versus either absolutely no bowel preparation or a single rectal enema was not associated with a statistically significant difference in the incidence of anastomotic leak, surgical site infection, intra-abdominal collection, mortality, reoperation, or total length of hospital stay [ 70 ]. This evidence was supported by other studies [ 64 , 71 ]. Several studies focusing on rectal surgery suggested that mechanical bowel preparation could be used selectively, even though no significant effect was found [ 72 , 73 ].…”

Enhanced recovery after surgery versus traditional care in total pelvic floor reconstruction surgery with transvaginal mesh

“…Studies have shown that excessive intravenous fluid is associated with delayed bowel function, postoperative ileus, postoperative nausea and vomiting, and prolonged lengths of stay . Early postoperative feeding can promote intestinal function recovery . Patients in the ERAS group avoided strict fasting and mechanical bowel preparation, and therefore did not need a large amount of intravenous fluid.…”

“…18 Early postoperative feeding can promote intestinal function recovery. 19,20 Patients in the ERAS group avoided strict fasting and mechanical bowel preparation, and therefore did not need a large amount of intravenous fluid. Regenbogen et al 21 showed that a higher fluid balance is associated with longer lengths of stay in patients who underwent hysterectomy.…”

Surgical approaches to colonic and rectal anastomosis: systematic review and meta-analysis

“…An improved profile of the anti-inflammatory cytokines IL-10 and IL-13 was observed in the IA group. Cortisol was increased in EA, while insulin was reduced in the EA group Mai-Phan et al (2019) [ 28 ] Colon Elective colon surgery Laparoscopy Handsewn (1 and 2 layers) CT scan, laparotomy, ultrasonography, clinical examination, lab tests, imaging tests - MBP (sodium phosphate or polyethylene glycol); intravenous antibiotic prophylaxis Anastomotic leakage, surgical-site infection, extra-abdominal complications, hospital stay, death Abdominal complications (anastomotic leak and surgical-site infection): 16.2% MBP, 18.3% no-MBP. Anastomotic leakage: 6.5% MBP, 3.3% no-MBP.…”