Requirement for bowel preparation in colorectal surgery

Abstract

To determine whether mechanical bowel preparation influences the incidence of anastomotic dehiscence following colorectal surgery, 186 patients undergoing elective left colonic or rectal resection were randomized before surgery to bowel preparation (n = 89) or no bowel preparation (n = 97). Surgical technique was standardized and no patient had a defunctioning colostomy. Seventeen patients were excluded (seven with preparation, ten without). Indications for surgery in the remaining 169 patients were carcinoma (133 patients), diverticular disease (26), inflammatory bowel disease (six) and miscellaneous conditions (four). Operations performed were left colonic resection or reversal of Hartmann's procedure (26 with preparation, 28 without) and anterior resection (56 versus 59). The overall morbidity rate (18 per cent) was similar in the two groups. All seven clinical anastomotic leaks occurred after low anterior resection, in three of the 39 patients who had undergone bowel preparation and four of the 36 who had not (P > 0.9). Two deaths occurred, both of patients who had received bowel preparation, one being secondary to anastomotic leakage. Bowel preparation does not influence outcome after elective colorectal surgery.

The measurement and monitoring of surgical adverse events

“…262 These complications led to policy revision, and contrast investigation was subsequently performed only when leak was suspected on clinical grounds.…”

“…Models created by restricting types of algorithms for identifying SSIs Gold standard: compared data sources did not perform as well compared by the use of coded elements against SSI data collected in to when all data sources were available, and or combination of elements previous study 177 it was not possible to create a model with a from automated medical sensitivity > 80% or a PPV > 35% without records, pharmacy records information on outpatient tests and diagnoses. and claims data, and to deterThus automated postdischarge medical records mine the level of performance detected SSIs with better sensitivity and that could be attained from specificity than did patient or surgeon surveys automated sources Seaman 262 UK (n = 186) Clinical features: anastomotic dehiscence was diagnosed clinically and Aim: a prospective RCT to suspected if there was: deterioration in the patient's general condition; determine whether mechanical bowel abdominal distension; diarrhoea or blood clot passed per anum; or signs of preparation influences the incidence peritonitis. If necessary, leak was confirmed radiologically by using a waterof anastomotic dehiscence following soluble enema colorectal surgery Investigations: in the first half of the series radiological leaks were routinely checked for in all patients with a colorectal anastomosis by administering a water-soluble contrast enema on day 7 postoperatively.Two of six leaks occurred on day 7 immediately after administration of a routine water-soluble contrast enema.These two complications led to a review of policy, and this investigation is now requested only when anastomotic leak is suspected on clinical grounds.Thus there are differences between the first and second half of this study Clinical features: neck wounds were inspected daily for evidence of Aim: to evaluate the use of a neck haematoma or seroma formation.The drain was removed when output drain after oesophagectomy in a was < 10 ml/day prospective RCT Investigations: on day 7 postoperatively, all patients had a water-soluble contrast study and endoscopy to detect subclinical as well as clinical leaks…”

Role of Mechanical Bowel Preparation in Preventing Anastomotic Leakage in Elective Colo-rectal Surgery

“…It almost invariably causes significant discomfort to the patient, including nausea, abdominal bloating, and diarrhea 15,16 . Mechanical bowel preparation is also associated with electrolyte imbalance and dehydration which may complicate the induction of anesthesia and peri-operative care 16 .…”

Preoperative mechanical bowel preparation in elective colorectal surgery: an update of systematic review of the literature and meta-analysis

“…The first review publication included five trials [24][25][26][27][28] , with total 824 participants: 408 patients in the group with mechanical bowel preparation (Group A) and 416 patients in the group without mechanical bowel preparation (Group B). The evidences found were insufficient to show statistical significance between the groups and a result that favored the group submitted to mechanical bowel preparation did not occur.…”

“…Eight trials included in our review were multicenter studies 17 Some studies included procedures without anastomosis 24,26,28,30,36 ; two excluded these participants from the clinical outcome of anastomotic dehiscence 24,36 ; four excluded patients not submitted to primary anastomosis 19,20,25,27 . Some authors performed temporary decompression of anastomosis, with ileostomy or colostomy 18,19,35 (Table 2).…”