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Sell NM, Francone TD. Anastomotic Troubleshooting. Clin Colon Rectal Surg 2021; 34:385-390. [PMID: 34853559 DOI: 10.1055/s-0041-1735269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Anastomotic leak remains a critical and feared complication in colorectal surgery. The development of a leak can be catastrophic for a patient, resulting in overall increased morbidity and mortality. To help mitigate this risk, there are several ways to assess and potentially validate the integrity of a new anastomosis to give the patient the best chance of avoiding this postoperative complication. A majority of anastomoses will appear intact with no obvious sign of anastomotic dehiscence on gross examination. However, each anastomosis should be interrogated before the conclusion of an operation. The most common method to assess for an anastomotic leak is the air leak test (ALT). The ALT is a safe intraoperative method utilized to test the integrity of left-sided colon and rectal anastomoses and most importantly allows the ability to repair a failed test before concluding the operation. Additional troubleshooting is sometimes needed due to technical difficulties with the circular stapler. Problems, such as incomplete doughnuts and stapler misfiring, do occur and each surgeon should be prepared to address them.
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Affiliation(s)
- Naomi M Sell
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.,Department of Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Todd D Francone
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.,Department of Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
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Luo J, Liu Z, Pei KY, Khan SA, Wang X, Yang M, Wang X, Zhang Y. The Role of Bowel Preparation in Open, Minimally Invasive, and Converted-to-Open Colectomy. J Surg Res 2019; 242:183-192. [PMID: 31085366 DOI: 10.1016/j.jss.2019.02.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/05/2019] [Accepted: 02/22/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Bowel preparation before colectomy is considered an effective strategy to decrease postoperative complications. However, data regarding the effect of bowel preparation in patients undergoing minimally invasive colectomy are limited. The aim of this study was to investigate the role of different bowel preparation strategies in patients undergoing open, minimally invasive, and converted-to-open elective colectomies. METHODS We identified 39,355 patients who underwent elective colectomy from the American College of Surgeons National Surgical Quality Improvement Program colectomy-targeted database (2012-2016). Multivariate logistic regression models were used to assess the impact of different bowel preparation strategies on postoperative complications and mortality in three subapproach groups: open (n = 12,141), minimally invasive (n = 23,057), and converted to open (n = 4157). RESULTS Overall, a total of 10,066 (25.6%) patients received no preparation (NP), 11,646 (29.5%) mechanical bowel preparation (MBP) alone, 1664 (4.2%) antibiotic bowel preparation (ABP) alone, and 15,979 (40.6%) MBP + ABP. Compared with NP, MBP + ABP showed the strongest protective effects. MBP + ABP was associated with reduced risk of major complications (odds ratio [OR] = 0.60, 95% confidence interval [CI]: 0.55-0.66), infectious complications (OR = 0.50, 95% CI: 0.46-0.54), any complications (OR = 0.55, 95% CI: 0.51-0.60), 30-d mortality (OR = 0.68, 95% CI: 0.48-0.96), anastomotic leak (OR = 0.50, 95% CI: 0.43-0.58), and length of stay ≥ 4 d (OR = 0.64, 95% CI: 0.61-0.67) in overall population. These protective effects, except for 30-d mortality, were observed in open, minimally invasive, and converted-to-open groups. When the analysis was limited to robotic surgery only, MBP + ABP was only associated with reduced risk of major complications (OR = 0.61, 95% CI: 0.38-0.97) compared with NP. The protective effects remained similar over the study time period. CONCLUSIONS MBP + ABP is a preferred preoperative strategy in open, minimally invasive, and converted-to-open colectomy.
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Affiliation(s)
- Jiajun Luo
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Zheng Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kevin Y Pei
- Department of Surgery, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Sajid A Khan
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Xiaoxu Wang
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Ming Yang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xishan Wang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Yawei Zhang
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut; Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut.
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Rosenfeld EH, Yu YR, Fernandes NJ, Karediya A, Wesson DE, Lopez ME, Shah SR, Vogel AM, Brandt ML. Bowel preparation for colostomy reversal in children. J Pediatr Surg 2019; 54:1045-1048. [PMID: 30782438 DOI: 10.1016/j.jpedsurg.2019.01.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 01/27/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Pediatric bowel preparation protocols used before colostomy reversal vary. The aim of this study is to determine institutional practices at our institution and evaluate the impact of bowel preparations on postoperative outcomes and hospital length of stay in children. METHODS This was a retrospective review of children ≤18 years old undergoing colostomy reversal at Texas Children's Hospital (TCH) between 12/2013 and 8/2017. Preoperative bowel regimens and outcomes were collected and analyzed using descriptive statistics, Wilcoxon Rank-Sum and Fishers Exact tests. Continuous variables are presented as median [IQR]. RESULTS Sixty-one children underwent colostomy reversal. Thirty-eight (62%) did not receive a preoperative bowel preparation. The two cohorts were similar in age, gender, and race. The most common indication for colostomy was anorectal malformation for thirty-seven (61%). Time from admission to surgery (19 h [17, 23] vs 3 [2, 3]; p < 0.01) and HLOS (6 days [5, 8] vs 5 [4, 6]; p = 0.02) were both longer in the bowel preparation cohort. Complications (3 [13%] vs 5 [22%]; p = 0.12) and 90-day readmissions (3 [13%] vs 6 [16%]; p = 0.64) were similar in both cohorts. CONCLUSION Foregoing bowel preparation may have the potential to improve cost and reduce morbidity in children undergoing colostomy closure. LEVEL OF EVIDENCE III. STUDY TYPE Treatment study.
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Affiliation(s)
- Eric H Rosenfeld
- Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Yangyang R Yu
- Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Nathaniel J Fernandes
- Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Aleena Karediya
- Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - David E Wesson
- Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Monica E Lopez
- Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Sohail R Shah
- Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Adam M Vogel
- Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Mary L Brandt
- Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX.
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Yang Y, Chen B, Xiang L, Guo C. Reduced rate of dehiscence after implementation of a novel technique for creating colonic anastomosis in pediatric patients undergoing intestinal anastomosis in a single institute. Medicine (Baltimore) 2019; 98:e15577. [PMID: 31083235 PMCID: PMC6531251 DOI: 10.1097/md.0000000000015577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We aimed to investigate the new continuous horizontal mattress anastomosis for pediatric patients who underwent emergency or electively laparotomy.From June 2012 to June 2017, 858 patients undergoing intestinal anastomosis were reviewed retrospectively, including 369 patients with the new continuous horizontal mattress anastomosis and 489 patients with traditional 2 layer interrupted anastomosis, served as control. Propensity score matching was performed to adjust for selected baseline variables. The primary outcome, anastomosis complications and clinical outcomes, including postoperative gastrointestinal function recovery, overall expenditure, and postoperative hospital stay were compared between the 2 groups.Patients with the new manual anastomosis had advantageous postoperative outcomes than those with the traditional 2 layer interrupted anastomosis. A mean of 11.4 minutes was required to construct the new manual single-layer anastomosis versus 18.5 minutes for the traditional anastomosis (P < .001). A reduction trend for postoperative anastomotic complications was indicated in patients receiving horizontal mattress anastomosis (odds ratio [OD] (95% confidence interval [CI]), 0.56 (0.37-0.84); P = .004), including peritonitis or abscess (OD [95% CI], 0.56 (0.32-0.98); P = .026), anastomotic leakage (OD [95% CI], 0.39 [0.12-1.27]; P = .088), and anastomotic strictures (P = .26). Mean length of stay was 10.9 ± 2.9 days for the new manual anastomosis group and 11.3 ± 3.5 days for traditional 2-layer anastomosis patients (P = .12).Beneficial effects of the new manual anastomosis were demonstrated in terms of anastomotic complications, and length of hospital stay in the pediatric patients. Furthermore, it is a novel, feasible and safe method that may simplify the surgical procedure in anastomoses.
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Affiliation(s)
- Yang Yang
- Department of Pediatric General Surgery and Liver Transplantation
| | - Bailin Chen
- Department of Pediatric General Surgery and Liver Transplantation
| | - Li Xiang
- Department of Pediatric General Surgery and Liver Transplantation
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital, Chongqing Medical University, Chongqing, P.R. China
| | - Chunbao Guo
- Department of Pediatric General Surgery and Liver Transplantation
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital, Chongqing Medical University, Chongqing, P.R. China
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Yost MT, Jolissaint JS, Fields AC, Whang EE. Mechanical and Oral Antibiotic Bowel Preparation in the Era of Minimally Invasive Surgery and Enhanced Recovery. J Laparoendosc Adv Surg Tech A 2018; 28:491-495. [PMID: 29630437 DOI: 10.1089/lap.2018.0072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION In the modern era of minimally invasive colorectal surgery and enhanced recovery pathways, the value of preoperative bowel preparation remains debated. In this review, we evaluate evidence regarding the use of mechanical bowel preparation (MBP) and oral antibiotic bowel preparation to make recommendations for their application in contemporary practice. METHODS We searched the PubMed database through December 2017 for relevant randomized controlled trials, Cochrane Reviews, American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database studies, and other reviews pertaining to MBP and oral antibiotic bowel preparation in elective colorectal surgery and conducted a narrative review. RESULTS The combination of MBP and oral antibiotics reduces the incidence of surgical site infection, anastomotic leak, and postoperative sepsis. MBP improves laparoscopic surgical viewing and facilitates intraoperative manipulation of the bowel in minimally invasive surgery. CONCLUSION Based on existing data, we recommend that preoperative care includes MBP and oral antibiotics in elective minimally invasive colorectal surgery.
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Affiliation(s)
- Mark T Yost
- 1 Harvard Medical School , Boston, Massachusetts
| | - Joshua S Jolissaint
- 1 Harvard Medical School , Boston, Massachusetts.,2 Department of Surgery, Brigham and Women's Hospital , Boston, Massachusetts
| | - Adam C Fields
- 1 Harvard Medical School , Boston, Massachusetts.,2 Department of Surgery, Brigham and Women's Hospital , Boston, Massachusetts
| | - Edward E Whang
- 1 Harvard Medical School , Boston, Massachusetts.,2 Department of Surgery, Brigham and Women's Hospital , Boston, Massachusetts.,3 Department of Surgery, VA Boston Healthcare System , West Roxbury, Massachusetts
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Sharpe JP, Magnotti LJ, Fabian TC, Croce MA. Evolution of the operative management of colon trauma. Trauma Surg Acute Care Open 2017; 2:e000092. [PMID: 29766094 PMCID: PMC5877907 DOI: 10.1136/tsaco-2017-000092] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 04/03/2017] [Indexed: 11/24/2022] Open
Abstract
For any trauma surgeon, colon wounds remain a relatively common, yet sometimes challenging, clinical problem. Evolution in operative technique and improvements in antimicrobial therapy during the past two centuries have brought remarkable improvements in both morbidity and mortality after injury to the colon. Much of the early progress in management and patient survival after colon trauma evolved from wartime experience. Multiple evidence-based studies during the last several decades have allowed for more aggressive management, with most wounds undergoing primary repair or resection and anastomosis with an acceptably low suture line failure rate. Despite the abundance of quality evidence regarding management of colon trauma obtained from both military and civilian experience, there remains some debate among institutions regarding management of specific injuries. This is especially true with respect to destructive wounds, injuries to the left colon, blunt colon trauma and those wounds requiring colonic discontinuity during an abbreviated laparotomy. Some programs have developed data-driven protocols that have simplified management of destructive colon wounds, clearly identifying those high-risk patients who should undergo diversion, regardless of mechanism or anatomic location. This update will describe the progression in the approach to colon injuries through history while providing a current review of the literature regarding management of the more controversial wounds.
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Affiliation(s)
- John P Sharpe
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Louis J Magnotti
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Timothy C Fabian
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Martin A Croce
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Arnold A, Aitchison LP, Abbott J. Preoperative Mechanical Bowel Preparation for Abdominal, Laparoscopic, and Vaginal Surgery: A Systematic Review. J Minim Invasive Gynecol 2015; 22:737-52. [DOI: 10.1016/j.jmig.2015.04.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 04/02/2015] [Accepted: 04/02/2015] [Indexed: 12/14/2022]
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Abstract
OBJECTIVES Adult literature supports the elimination of mechanical bowel preparation (MBP) for elective colorectal surgical procedures. Prospective data for the pediatric population regarding the utility of MBP are lacking. The primary aim of this study was to compare infectious complications, specifically anastomotic leak, intraabdominal abscess, and wound infection in patients who received MBP with those who did not. METHODS A randomized pilot study comparing MBP with polyethylene glycol with no MBP was performed. Patients, 0 to 21 years old, undergoing elective colorectal surgery were eligible and randomized within 4 age strata. Statistical analyses were performed using χ or Fisher exact test for categorical data and t test or Wilcoxon 2-sample test for continuous data. RESULTS Forty-four patients were enrolled in the study from December 2010 to February 2013, of which 24 (55%) received MBP and 20 (45%) did not. Two patients (5%) had anastomotic leak, 4 (9%) had intraabdominal infection, and 7 (16%) had wound infections. The rate of anastomotic leak, intraabdominal abscess, and wound infection did not differ between the 2 groups. CONCLUSIONS MBP for elective colorectal surgery in children does not affect the incidence of infectious complications. A larger multiinstitutional study is necessary to validate the results of this single-institution pilot study.
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Azari Y, Perry Z, Kirshtein B. Strangulated groin hernia in octogenarians. Hernia 2013; 19:443-7. [PMID: 24366756 DOI: 10.1007/s10029-013-1205-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 12/12/2013] [Indexed: 02/03/2023]
Abstract
UNLABELLED The aim of the study was to determine risk factors for morbidity and mortality in patients older than 80 years, compared to younger patients, who undergo emergency strangulated groin hernia repair. METHODS This is a retrospective study of patients who underwent emergency surgery for strangulated groin hernia repair during 14 years. Patients were divided by age into three groups: younger than 59 (group A), 60-79 (group B), and older than 80 years (group C). Patient data included age, gender, hernia type, sac content, comorbidities, and surgical outcomes. RESULTS Two hundred patients were included in the study. There was no difference between groups in sex, hernia localization, and the type of repair. More comorbidities were found in octogenarians compared to the younger patients [group C vs. D (A + B)]. Small bowel resections and ICU admissions were more frequent in patients over 60 years compared to younger patients, 19.6 and 32.7 % vs. 1.7 and 0 %, respectively. Surgery was longer in group B. The rate of postoperative complications, repeated surgery, length of admission, and mortality were significantly higher in octogenarian (group C). Multivariate analysis found that age is a significant factor in the occurrence of non-surgical postoperative complications, but not in surgical complications. CONCLUSION Emergency surgery for strangulated hernia repair in patients over 80 years is more complicated than in younger patients, mostly due to the existing comorbidities. In order to reduce the high morbidity and mortality rates in emergency surgery associated with this age group, elective hernia surgery in elderly should be considered in selected patients with severe symptoms affecting their daily life.
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Affiliation(s)
- Y Azari
- Department of Surgery A, Soroka University Medical Center, Beersheba, Israel
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10
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Applicability of an established management algorithm for colon injuries following blunt trauma. J Trauma Acute Care Surg 2013; 74:419-24; discussion 424-5. [DOI: 10.1097/ta.0b013e31827a36e9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Serrurier K, Liu J, Breckler F, Khozeimeh N, Billmire D, Gingalewski C, Gollin G. A multicenter evaluation of the role of mechanical bowel preparation in pediatric colostomy takedown. J Pediatr Surg 2012; 47:190-3. [PMID: 22244415 DOI: 10.1016/j.jpedsurg.2011.10.044] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Accepted: 10/08/2011] [Indexed: 02/09/2023]
Abstract
BACKGROUND In response to studies in adults that have failed to demonstrate a benefit for mechanical bowel preparation in colonic surgery, we sought to evaluate the utility of mechanical bowel preparation in a multicenter, retrospective study of children who underwent colostomy takedown. METHODS The records of 272 children who underwent colostomy takedown at 3 large children's hospitals were reviewed, and the utilization of mechanical bowel preparation and perioperative antibiotics was noted. Length of stay and the incidences of wound, anastomotic, and other complications were compared. RESULTS A polyethylene glycol bowel prep was administered to 187 children. All subjects received perioperative, intravenous antibiotics, and 52% of those with bowel preps received preoperative oral antibiotics. Subjects in the bowel prep group had a significantly higher incidence of wound infection (P = .04) and longer length of stay (P = .05). Oral antibiotics did not affect outcome. CONCLUSIONS The use of a mechanical bowel preparation in children before colostomy takedown was associated with a greater risk for wound infection, no protection from other complications, and a longer length of stay. This suggests that bowel preparation may be safely omitted in many children who undergo colonic surgery, thereby reducing cost and discomfort.
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Affiliation(s)
- Katherine Serrurier
- Division of Pediatric Surgery, Loma Linda University School of Medicine and Children's Hospital, Loma Linda, CA 92354, USA
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Lavu H, Kennedy EP, Mazo R, Stewart RJ, Greenleaf C, Grenda DR, Sauter PK, Leiby BE, Croker SP, Yeo CJ. Preoperative mechanical bowel preparation does not offer a benefit for patients who undergo pancreaticoduodenectomy. Surgery 2010; 148:278-84. [PMID: 20447669 DOI: 10.1016/j.surg.2010.03.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Accepted: 03/15/2010] [Indexed: 01/04/2023]
Abstract
BACKGROUND Mechanical bowel preparations (MBPs) are commonly administered preoperatively to patients who undergo pancreaticoduodenectomy (PD); however, their effectiveness over a clear liquid diet (CLD) preparation remains unclear. The aim of this study was to determine whether MBP offers an advantage to patients who undergo PD. METHODS In this retrospective review, we analyzed the clinical data from 100 consecutive PDs performed on patients who received preoperative MBP from March 2006 to April 2007, and we compared them with 100 consecutive patients who received a preoperative CLD from May 2007 to March 2008. RESULTS No differences were observed between the MBP and CLD groups in the rates of pancreatic fistula (13% vs 14%; P = 1.0), intra-abdominal abscess (11% vs 13%; P = .83), or wound infection (9% vs 8%; P = 1.0). Trends toward increased urinary tract infections (13% vs 5%; P < .08) and Clostridium difficile infections were found in the MBP group (6% vs 1%; P = .12). The median duration of postoperative hospital stay was 7 days in each group, and the 12-month survival rates were equivalent (74% vs 75%; P = 1.0). CONCLUSION There is no clinical benefit to the administration of a preoperative MBP for patients undergoing PD.
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Affiliation(s)
- Harish Lavu
- Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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Scabini S, Rimini E, Romairone E, Scordamaglia R, Damiani G, Pertile D, Ferrando V. Colon and rectal surgery for cancer without mechanical bowel preparation: one-center randomized prospective trial. World J Surg Oncol 2010; 8:35. [PMID: 20433721 PMCID: PMC2873340 DOI: 10.1186/1477-7819-8-35] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Accepted: 04/30/2010] [Indexed: 02/07/2023] Open
Abstract
Background Mechanical bowel preparation is routinely done before colon and rectal surgery, aimed at reducing the risk of postoperative infectious complications. The aim of the study was to assess whether elective colon and rectal surgery can be safely performed without preoperative mechanical bowel preparation. Methods Patients undergoing elective colon and rectal resections with primary anastomosis were prospectively randomized into two groups. Group A had mechanical bowel preparation with polyethylene glycol before surgery, and group B had their surgery without preoperative mechanical bowel preparation. Patients were followed up for 30 days for wound, anastomotic, and intra-abdominal infectious complications. Results Two hundred forty four patients were included in the study, 120 in group A and 124 in group B. Demographic characteristics, type of surgical procedure and type of anastomosis did not significantly differ between the two groups. There was no difference in the rate of surgical infectious complications between the two groups but the overall infectious complications rate was 20.0% in group A and 11.3% in group B (p .05). Wound infection (p = 0.18), anastomotic leak (p = 0.52), and intra-abdominal abscess (p = 0.36) occurred in 9.2%, 5.8%, and 5.0% versus 4.8%, 4.0%, and 2.4%, respectively. No mechanical bowel preparation seems to be safe also in rectal surgery. Conclusions These results suggest that elective colon and rectal surgery may be safely performed without mechanical preparation.
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Affiliation(s)
- Stefano Scabini
- Unit of Surgical Oncology, Department of Emato-Oncology, San Martino Hospital, Genoa, Italy.
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