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Schooley B, San Nicolas-Rocca T, Burkhard R. Cloud-based multi-media systems for patient education and adherence: a pilot study to explore patient compliance with colonoscopy procedure preparation. Health Syst (Basingstoke) 2019; 10:89-103. [PMID: 34104428 DOI: 10.1080/20476965.2019.1663974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Technology based patient education and adherence approaches are increasingly utilized to instruct and remind patients to prepare correctly for medical procedures. This study examines the interaction between two primary factors: patterns of patient adherence to challenging medical preparation procedures; and the demonstrated, measurable potential for cloud-based multi-media information technology (IT) interventions to improve patient adherence. An IT artifact was developed through prior design science research to serve information, reminders, and online video instruction modules to patients. The application was tested with 297 patients who were assessed clinically by physicians. Results indicate modest potential (43.4% relative improvement) for the IT-based approach for improving patient adherence to endoscopy preparations. Purposively designed cloud-based applications hold promise for aiding patients with complex medical procedure preparation. Health care provider involvement in the design and evaluation of a patient application may be an effective strategy to produce medical evidence and encourage the adoption of adherence apps.
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Affiliation(s)
- Benjamin Schooley
- Health Information Technology, University of South Carolina, College of Engineering and Computing, Columbia, SC, USA
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2
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Lewis J, Kinross J. Mechanical bowel preparation for elective colorectal surgery. Tech Coloproctol 2019; 23:783-785. [PMID: 31471775 PMCID: PMC6736893 DOI: 10.1007/s10151-019-02061-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 08/05/2019] [Indexed: 02/08/2023]
Affiliation(s)
- J Lewis
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | - J Kinross
- Department of Surgery and Cancer, Imperial College London, London, UK
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3
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Ertas IE, Ince O, Emirdar V, Gultekin E, Biler A, Kurt S. Influence of preoperative enema application on the return of gastrointestinal function in elective Cesarean sections: a randomized controlled trial. J Matern Fetal Neonatal Med 2019; 34:1822-1826. [PMID: 31397204 DOI: 10.1080/14767058.2019.1651264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIM There is an extensive literature on the mechanical bowel preparation by an enema in colorectal, abdominal, and gynecologic surgeries that provide evidence against the use of enema. There are, however, few studies investigating the effect of enema prior to elective Cesarean sections. The aim of this study is to investigate whether preoperative enema facilitates the return of gastrointestinal activity in pregnant women undergoing elective Cesarean section. MATERIALS AND METHODS The surgeon-blinded prospective randomized controlled study included 225 elective Cesarean patients between the ages of 18 and 44. The patients were randomized into two groups: those who had enema preoperatively (n = 114) and those who did not (n = 111). The outcome measures were first bowel sound time and first flatus time, the length of hospital stay, the rate of mid ileus symptoms, and additional analgesic and antiemetic need. RESULTS In the non-enema group, the time of the first bowel sound, flatus time, length of hospital stay, the rates of additional analgesic need, additional antiemetic need, and mild ileus symptoms were respectively 10.5 ± 5.8 hours, 16.0 ± 7.6 hours, 1.9 ± 0.3 days, 8.1%, 7.2%, and 2.7%. For the enema group, the same parameters were respectively 11.6 ± 4.7 hours, 17.5 ± 6.5 hours, 1.8 ± 0.3 days, 7%, 6.1% ,and 1.8%. For all parameters, the difference between the groups was not statistically significant (p values were respectively .09, .12, .8, .79, .68, and .26). CONCLUSIONS The study suggests that preoperative enema in elective cesarean sections does not prevent postoperative gastrointestinal complications and does not shorten the recovery of bowel movements or length of hospital stay.
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Affiliation(s)
- Ibrahim Egemen Ertas
- Department of Gynecology and Obstetrics, University of Health Sciences, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Onur Ince
- Department of Gynecology and Obstetrics, University of Health Sciences, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Volkan Emirdar
- Department of Gynecology and Obstetrics, University of Health Sciences, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Emre Gultekin
- Department of Gynecology and Obstetrics, University of Health Sciences, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Alper Biler
- Department of Gynecology and Obstetrics, University of Health Sciences, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Sefa Kurt
- Department of Gynecology and Obstetrics, University of Health Sciences, Tepecik Education and Research Hospital, Izmir, Turkey
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Rollins KE, Javanmard-Emamghissi H, Lobo DN. Impact of mechanical bowel preparation in elective colorectal surgery: A meta-analysis. World J Gastroenterol 2018; 24:519-536. [PMID: 29398873 PMCID: PMC5787787 DOI: 10.3748/wjg.v24.i4.519] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 10/25/2017] [Accepted: 11/08/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To analyse the effect of mechanical bowel preparation vs no mechanical bowel preparation on outcome in patients undergoing elective colorectal surgery. METHODS Meta-analysis of randomised controlled trials and observational studies comparing adult patients receiving mechanical bowel preparation with those receiving no mechanical bowel preparation, subdivided into those receiving a single rectal enema and those who received no preparation at all prior to elective colorectal surgery. RESULTS A total of 36 studies (23 randomised controlled trials and 13 observational studies) including 21568 patients undergoing elective colorectal surgery were included. When all studies were considered, mechanical bowel preparation was not associated with any significant difference in anastomotic leak rates (OR = 0.90, 95%CI: 0.74 to 1.10, P = 0.32), surgical site infection (OR = 0.99, 95%CI: 0.80 to 1.24, P = 0.96), intra-abdominal collection (OR = 0.86, 95%CI: 0.63 to 1.17, P = 0.34), mortality (OR = 0.85, 95%CI: 0.57 to 1.27, P = 0.43), reoperation (OR = 0.91, 95%CI: 0.75 to 1.12, P = 0.38) or hospital length of stay (overall mean difference 0.11 d, 95%CI: -0.51 to 0.73, P = 0.72), when compared with no mechanical bowel preparation, nor when evidence from just randomized controlled trials was analysed. A sub-analysis of mechanical bowel preparation vs absolutely no preparation or a single rectal enema similarly revealed no differences in clinical outcome measures. CONCLUSION In the most comprehensive meta-analysis of mechanical bowel preparation in elective colorectal surgery to date, this study has suggested that the use of mechanical bowel preparation does not affect the incidence of postoperative complications when compared with no preparation. Hence, mechanical bowel preparation should not be administered routinely prior to elective colorectal surgery.
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Affiliation(s)
- Katie E Rollins
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute of Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UH, United Kingdom
| | - Hannah Javanmard-Emamghissi
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute of Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UH, United Kingdom
| | - Dileep N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute of Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UH, United Kingdom
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Abstract
OBJECTIVES To examine whether the administration of mechanical bowel preparation (MBP) plus oral antibiotic bowel preparation (OABP) was associated with reduced surgical site infections (SSIs), which in turn leads to a reduction of non-SSI-related postoperative complications. BACKGROUND Administration of MBP/OABP before elective colectomy reduces the incidence of SSI. We hypothesized that reduction of SSI is on causal pathway between the use of MBP/OABP and the reduction of other postoperative complications. METHODS The study population consisted of all colectomy cases in the American College of Surgeons National Surgical Quality Improvement Program Colectomy Targeted Participant Use Data File for 2012 and 2013. Postoperative outcomes were compared based on the type of bowel preparation: none, MBP only, OABP only, and MBP plus OABP adjusting for other covariates. RESULTS The cohort included 19,686 patients. Of these 5060 (25.7%) patients did not receive any form of bowel preparation, 8020 (40.7%) received MBP only, 641 (3.3%) received OABP only, and 5965 (30.3%) received MBP plus OABP. Patients who received MBP plus OABP had a lower incidence of superficial SSI, deep SSI, organ space SSI, any SSI, anastomotic leak, postoperative ileus, sepsis, readmission, and reoperation compared with patients who received neither (all P < 0.01). The reduction in SSI incidence was associated with a reduction in wound dehiscence, anastomotic leak, pneumonia, prolonged requirement of mechanical ventilator, sepsis, septic shock, readmission, and reoperation. CONCLUSIONS Combined MBP plus OABP before elective colectomy was associated with reduced SSI, which ultimately was associated with a reduction in non-SSI-related complications.
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胡 艳, 李 卡, 李 立, 汪 晓, 杨 婕, 冯 金, 张 薇, 刘 雨. [Early outcomes of elective surgery for colon cancer with preoperative mechanical bowel preparation: a randomized clinical trial]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:13-17. [PMID: 28109092 PMCID: PMC6765765 DOI: 10.3969/j.issn.1673-4254.2017.01.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To compared the early outcomes of patients undergoing elective surgeries for colon cancer with and without preoperative mechanical bowel preparation. METHODS Between July, 2014 and February, 2016, patients undergoing elective surgery for colon cancer with primary anastomosis were randomly assigned into control group with mechanical bowel preparation 12 h before surgery and treatment group without mechanical bowel preparation. Baseline data collection was completed within 12 h after the operation. The levels of hemoglobin, total protein, albumin, prealbumin and albumin<globulin ratio of the patients were recorded at 1 day before surgery and 1 day and 5 days after the surgery. The patients were followed up till 30 days after the surgeries and the complications were recorded. RESULTS Seventy-six patients were assigned in the treatment group and 72 in the control group. Significant differences were found in the incidence of wound infection and intra-abdominal infection (P<0.05) but not in that of anastomotic leakage or early postoperative bowel obstruction (P>0.05) between the two 2 groups. The first flatus time (P=0.03) and prealbumin level on the first postoperative day (P=0.03) differed significantly between the two groups, but the operation time was similar between them (P=0.06). CONCLUSION In patients undergoing elective surgeries for colon cancer, preoperative mechanical bowel preparation is associated with increased postoperative complications, delayed recovery of intestinal motility and poorer nutrition status early after the operation.
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Affiliation(s)
- 艳杰 胡
- />四川大学华西医院,四川 成都 610041West China Hospital, Sichuan University, Chengdu 610041, China
| | - 卡 李
- />四川大学华西医院,四川 成都 610041West China Hospital, Sichuan University, Chengdu 610041, China
| | - 立 李
- />四川大学华西医院,四川 成都 610041West China Hospital, Sichuan University, Chengdu 610041, China
| | - 晓东 汪
- />四川大学华西医院,四川 成都 610041West China Hospital, Sichuan University, Chengdu 610041, China
| | - 婕 杨
- />四川大学华西医院,四川 成都 610041West China Hospital, Sichuan University, Chengdu 610041, China
| | - 金华 冯
- />四川大学华西医院,四川 成都 610041West China Hospital, Sichuan University, Chengdu 610041, China
| | - 薇 张
- />四川大学华西医院,四川 成都 610041West China Hospital, Sichuan University, Chengdu 610041, China
| | - 雨薇 刘
- />四川大学华西医院,四川 成都 610041West China Hospital, Sichuan University, Chengdu 610041, China
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胡 艳, 李 卡, 李 立, 汪 晓, 杨 婕, 冯 金, 张 薇, 刘 雨. [Early outcomes of elective surgery for colon cancer with preoperative mechanical bowel preparation: a randomized clinical trial]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:13-17. [PMID: 28109092 PMCID: PMC6765765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Indexed: 07/30/2024]
Abstract
OBJECTIVE To compared the early outcomes of patients undergoing elective surgeries for colon cancer with and without preoperative mechanical bowel preparation. METHODS Between July, 2014 and February, 2016, patients undergoing elective surgery for colon cancer with primary anastomosis were randomly assigned into control group with mechanical bowel preparation 12 h before surgery and treatment group without mechanical bowel preparation. Baseline data collection was completed within 12 h after the operation. The levels of hemoglobin, total protein, albumin, prealbumin and albumin RESULTS Seventy-six patients were assigned in the treatment group and 72 in the control group. Significant differences were found in the incidence of wound infection and intra-abdominal infection (P<0.05) but not in that of anastomotic leakage or early postoperative bowel obstruction (P>0.05) between the two 2 groups. The first flatus time (P=0.03) and prealbumin level on the first postoperative day (P=0.03) differed significantly between the two groups, but the operation time was similar between them (P=0.06). CONCLUSION In patients undergoing elective surgeries for colon cancer, preoperative mechanical bowel preparation is associated with increased postoperative complications, delayed recovery of intestinal motility and poorer nutrition status early after the operation.
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Affiliation(s)
- 艳杰 胡
- />四川大学华西医院,四川 成都 610041West China Hospital, Sichuan University, Chengdu 610041, China
| | - 卡 李
- />四川大学华西医院,四川 成都 610041West China Hospital, Sichuan University, Chengdu 610041, China
| | - 立 李
- />四川大学华西医院,四川 成都 610041West China Hospital, Sichuan University, Chengdu 610041, China
| | - 晓东 汪
- />四川大学华西医院,四川 成都 610041West China Hospital, Sichuan University, Chengdu 610041, China
| | - 婕 杨
- />四川大学华西医院,四川 成都 610041West China Hospital, Sichuan University, Chengdu 610041, China
| | - 金华 冯
- />四川大学华西医院,四川 成都 610041West China Hospital, Sichuan University, Chengdu 610041, China
| | - 薇 张
- />四川大学华西医院,四川 成都 610041West China Hospital, Sichuan University, Chengdu 610041, China
| | - 雨薇 刘
- />四川大学华西医院,四川 成都 610041West China Hospital, Sichuan University, Chengdu 610041, China
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Piroglu I, Tulgar S, Thomas DT, Cakiroglu B, Piroglu MD, Bozkurt Y, Gergerli R, Ates NG. Mechanical Bowel Preparation Does Not Affect Anastomosis Healing in an Experimental Rat Model. Med Sci Monit 2016; 22:26-30. [PMID: 26725402 PMCID: PMC4706103 DOI: 10.12659/msm.895804] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Mechanical bowel preparation before colorectal surgery is commonly performed, but its benefits are controversial. The aim of this study was to compare the effects of mechanical bowel preparation on healing of colonic anastomosis and tissue strength. Material/Methods After institutional review board approval, 20 adult Wistar albino rats were randomly divided into 2 groups of 10 animals each. Mechanical bowel preparation including sodium phosphate was performed on the experimental group via a feeding tube, whereas no bowel preparation procedures were performed on the control group. Transverse colon resection and anastomosis were performed on all rats under general anaesthesia. On postoperative day 5, re-laparotomy was performed and the anastomotic areas were resected. Animals were killed, after which bursting pressure and tissue hydroxyproline concentrations were measured, histopathological examination was performed, and we evaluated and compared the results. Results There were no differences between control and experimental groups in bursting pressure, tissue hydroxyproline concentrations, or histopathological examination results (P>0.05). Conclusions Our study demonstrated no significant difference between bursting pressures, tissue hydroxyproline levels, or modified wound healing score at postoperative day 5 between rats undergoing and not undergoing mechanical bowel preparation. Mechanical bowel preparation is not essential for healing or strength of colonic anastomosis in rats.
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Affiliation(s)
- Isılay Piroglu
- Department of General Surgery, Bitlis State Hospital, Bitlis, Turkey
| | - Serkan Tulgar
- Department of Anesthesiology & Reanimation, Pendik State Hospital, Istanbul, Turkey
| | | | - Basri Cakiroglu
- Department of Urology, Hisar Intercontinental Hospital, Istanbul, Turkey
| | | | - Yasin Bozkurt
- Department of Emergency Medicine, Bitlis State Hospital, Bitlis, Turkey
| | - Ruken Gergerli
- Department of Anesthesiology & Reanimation, Karakocan State Hospital, Elazig, Turkey
| | - Nagihan Gozde Ates
- Department of Anesthesiology & Reanimation, Gumushane State Hospital, Gumushane, Turkey
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Elnahas A, Urbach D, Lebovic G, Mamdani M, Okrainec A, Quereshy FA, Jackson TD. The effect of mechanical bowel preparation on anastomotic leaks in elective left-sided colorectal resections. Am J Surg 2015; 210:793-8. [DOI: 10.1016/j.amjsurg.2015.03.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 03/23/2015] [Accepted: 03/30/2015] [Indexed: 10/23/2022]
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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
BACKGROUND Oral mechanical bowel preparation is often used before elective colorectal surgery to reduce postoperative complications. OBJECTIVE The purpose of this study was to synthesize the evidence on the comparative effectiveness and safety of oral mechanical bowel preparation versus no preparation or enema. DATA SOURCES We searched MEDLINE, the Cochrane Central Register of Controlled Trials, Embase, and CINAHL without any language restrictions (last search on September 6, 2013). We also searched the US Food and Drug Administration Web site and ClinicalTrials.gov and supplemented our searches by asking technical experts and perusing reference lists. STUDY SELECTION We included English-language, full-text reports of randomized clinical trials and nonrandomized comparative studies of patients undergoing elective colon or rectal surgery. For adverse events we also included single-group cohort studies of at least 200 participants. INTERVENTIONS Interventions included oral mechanical bowel preparation, oral mechanical bowel preparation plus enema, enema only, and no oral mechanical bowel preparation or enema. MAIN OUTCOME MEASURES Anastomotic leakage, all-cause mortality, wound infection, peritonitis/intra-abdominal abscess, reoperation, surgical site infection, quality of life, length of stay, and adverse events were measured. We synthesized results across studies qualitatively and with Bayesian random-effects meta-analyses. RESULTS A total of 18 randomized clinical trials, 7 nonrandomized comparative studies, and 6 single-group cohorts were included. In meta-analyses of randomized clinical trials, the credibility intervals of the summary OR included the null value of 1.0 for comparisons of oral mechanical bowel preparation and either no oral preparation or enema for overall mortality, anastomotic leakage, wound infection, peritonitis, surgical site infection, and reoperation. These results were robust to extensive sensitivity analyses. Evidence on adverse events was sparse. LIMITATIONS The study was limited by weaknesses in the underlying evidence, such as incomplete reporting of relevant information, exclusion of non-English and relevant unpublished studies, and possible missed indexing of nonrandomized studies. CONCLUSIONS Our results could not exclude modest beneficial or harmful effects of oral mechanical bowel preparation compared with no preparation or enema.
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McDermott FD, Heeney A, Kelly ME, Steele RJ, Carlson GL, Winter DC. Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg 2015; 102:462-79. [PMID: 25703524 DOI: 10.1002/bjs.9697] [Citation(s) in RCA: 517] [Impact Index Per Article: 57.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 09/09/2014] [Accepted: 10/08/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Anastomotic leak (AL) represents a dreaded complication following colorectal surgery, with a prevalence of 1-19 per cent. There remains a lack of consensus regarding factors that may predispose to AL and the relative risks associated with them. The objective was to perform a systematic review of the literature, focusing on the role of preoperative, intraoperative and postoperative factors in the development of colorectal ALs. METHODS A systematic review was performed to identify adjustable and non-adjustable preoperative, intraoperative and postoperative factors in the pathogenesis of AL. Additionally, a severity grading system was proposed to guide treatment. RESULTS Of 1707 papers screened, 451 fulfilled the criteria for inclusion in the review. Significant preoperative risk factors were: male sex, American Society of Anesthesiologists fitness grade above II, renal disease, co-morbidity and history of radiotherapy. Tumour-related factors were: distal site, size larger than 3 cm, advanced stage, emergency surgery and metastatic disease. Adjustable risk factors were: smoking, obesity, poor nutrition, alcohol excess, immunosuppressants and bevacizumab. Intraoperative risk factors were: blood loss/transfusion and duration of surgery more than 4 h. Stomas lessen the consequences but not the prevalence of AL. In the postoperative period, CT is the most commonly used imaging tool, with or without rectal contrast, and a C-reactive protein level exceeding 150 mg/l on day 3-5 is the most sensitive biochemical marker. A five-level classification system for AL severity and appropriate management is presented. CONCLUSION Specific risk factors and their potential correction or indications for stoma were identified. An AL severity score is proposed to aid clinical decision-making.
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Affiliation(s)
- F D McDermott
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
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14
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Rangel SJ, Islam S, St Peter SD, Goldin AB, Abdullah F, Downard CD, Saito JM, Blakely ML, Puligandla PS, Dasgupta R, Austin M, Chen LE, Renaud E, Arca MJ, Calkins CM. Prevention of infectious complications after elective colorectal surgery in children: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee comprehensive review. J Pediatr Surg 2015; 50:192-200. [PMID: 25598122 DOI: 10.1016/j.jpedsurg.2014.11.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 11/03/2014] [Accepted: 11/03/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This goal of this review was to examine the clinical evidence in support of commonly utilized measures intended to reduce complications following elective colorectal surgery. DATA SOURCE Literature searches were performed to identify relevant studies from Medline, PubMed, and Cochrane databases. STUDY SELECTION The American Pediatric Surgery Association Outcomes and Clinical Trials Committee selected eight questions to address this topic systematically in the context of three management areas: 1) appropriate utilization of systemic antibiotics for colorectal procedures, 2) reduction of stool burden through mechanical bowel preparation, and 3) intraluminal gut decontamination through use of enteral nonabsorbable antibiotics. Primary outcomes of interest included the occurrence of infectious and mechanical complications related to stool burden and intraluminal bacterial concentration (incisional surgical site infection, anastomotic leakage, and intraabdominal abscess). RESULTS The evidence in support of each management category was systematically reviewed, graded, and summarized in the context of the review's primary outcomes. Practice recommendations were made as deemed appropriate by the committee. CONCLUSIONS Clinical evidence in support of interventions to reduce infectious complications following colorectal surgery is derived almost exclusively from the adult literature. High-quality evidence to guide clinical practice in children is sorely needed, as the available data may have only limited relevance to pediatric colorectal diseases.
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Affiliation(s)
- Shawn J Rangel
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Saleem Islam
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Shawn D St Peter
- Children's Mercy Hospital, University of Missouri, Kansas City, MO, USA
| | - Adam B Goldin
- Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | | | | | - Jacqueline M Saito
- St. Louis Children's Hospital, Washington University, St. Louis, MO, USA
| | | | | | - Roshni Dasgupta
- Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Mary Austin
- Children's Memorial Hermann Hospital, University of Texas, Houston, TX, USA
| | - Li Ern Chen
- Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Marjorie J Arca
- Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Casey M Calkins
- Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
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15
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Brown SR, Ali MS, Williams M, Swisher JP, Rice WV, Coviello LC, Huitron SS, Davis KG. Cellular changes of the colon after mechanical bowel preparation. J Surg Res 2014; 193:619-25. [PMID: 25277353 DOI: 10.1016/j.jss.2014.08.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 08/13/2014] [Accepted: 08/21/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the effect of mechanical bowel preparation (MBP) on the intracellular environment, specifically evaluating butyrate transport, within the colon of the Sprague-Dawley rat. METHODS Sixty-eight Sprague-Dawley rats were randomized to either an MBP group (n = 34) or a control group (n = 34). Twenty-four hours after the completion of the MBP, both groups were euthanized, and the colons were harvested. The level of cellular apoptosis was investigated after DNA fragmentation, poly(ADP-ribose) polymerase cleavage, and caspase assays. Western blot analysis was performed to measure the expression of the butyrate transporter protein, monocarboxylate transporters 1, and proliferating cell nuclear antigen (a marker for tissue proliferation). Immunohistochemical staining was performed to further investigate cellular proliferation. Statistical significance (P < 0.05) was determined using two-tailed t-test. RESULTS Apoptosis was detected without significant differences in both groups. Western Blot analysis demonstrated that the expression of the monocarboxylate transporters 1 protein is downregulated in the MBP group (10.18 ± 3.09) compared with the control group (16.73 ± 7.39, P = 0.001), and proliferating cell nuclear antigen levels showed a decrease in cellular proliferation in the MBP group (13.35 ± 5.88) compared with the control (20.07 ± 7.55, P = 0.018). Immunohistochemistry confirmed a decrease in cellular proliferation after MBP with 23.4 ± 7.8% of the cells staining positive for Ki-67 in the MBP group versus 28.6 ± 7.9% in the control group (P = 0.006). CONCLUSIONS MBP has a negative impact on cellular proliferation and intracellular transport of butyrate within the rat colon, not related to apoptosis. This is the first study to demonstrate the intracellular effects that MBP has on the rat colon.
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Affiliation(s)
- Shaun R Brown
- Department of Surgery, William Beaumont Army Medical Center, El Paso, Texas.
| | - Mohammed S Ali
- Department of Clinical Investigation, William Beaumont Army Medical Center, El Paso, Texas
| | - Matthew Williams
- Department of Surgery, William Beaumont Army Medical Center, El Paso, Texas
| | - Jonathan P Swisher
- Department of Surgery, William Beaumont Army Medical Center, El Paso, Texas
| | - William V Rice
- Department of Surgery, William Beaumont Army Medical Center, El Paso, Texas
| | - Lisa C Coviello
- Department of Surgery, William Beaumont Army Medical Center, El Paso, Texas
| | - Sonny S Huitron
- Department of Pathology, William Beaumont Army Medical Center, El Paso, Texas
| | - Kurt G Davis
- Department of Surgery, William Beaumont Army Medical Center, El Paso, Texas
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Bowel preparation for colorectal surgery: with and without mannitol. GASTROENTEROLOGY REVIEW 2013; 8:305-7. [PMID: 24868274 PMCID: PMC4027823 DOI: 10.5114/pg.2013.38733] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Revised: 01/06/2013] [Accepted: 02/16/2013] [Indexed: 11/21/2022]
Abstract
Introduction In our country due to some limitations, mannitol is widely used for bowel preparation. Bowel preparation with mannitol has several side effects. Aim To compare complication of mechanical bowel preparation with and without mannitol. Material and methods This case control study was carried out in Imam Khomeini and Abuzar children’s hospitals. Sixty cases of patients who underwent colorectal surgery were included in this study. Pull-through, colostomy closure, and anorectoplasty were the surgical procedures. Subjects were randomly placed in the case or control group. Infection, electrolyte disturbances, fever, and leukocytosis were recorded. Multivariate analysis was done using PRISM. Odds ratio was calculate with CI = 95%. Results Fourteen boys and 16 girls were included in group I. Ten boys and 20 girls were included in group II. Twenty colostomies, 6 pull-throughs, and 4 anorectoplasties were performed in group I. Twenty-one colostomies, 5 pull-throughs, and 4 anorectoplasties were done in group II. Mean age of the patients was 2.63 ±1.9 and 2.66 ±1.68 for group I and group II respectively (p = 0.262). Following bowel preparation with mannitol, 14 patients had mild fever with mean body temperature of 38.1°C. Three subjects had postsurgical fever within 48 h of surgery. In group II, postoperative fever was found in 2 subjects. Conclusions Hypernatremia, hypokalemia, and leukocytosis were more common in patients who underwent bowel preparation with mannitol.
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Abstract
Mechanical bowel preps were initially thought to decrease the bacterial load of the colon and therefore decrease infection. Traditional bowel preps include osmotic, laxative, and combination regimen. Data demonstrate that mechanical bowel preps are generally equivalent; however, the addition of oral antibiotics may further reduce the risk of infection. Recent data suggest that mechanical bowel preparations may not be necessary, and that dietary restrictions before surgery may also be obsolete. In this review, the authors address the types of mechanical bowel preparations (MBPs), differences in outcomes between MBPs, the role of oral antibiosis and enemas, the benefits of no MBP, and dietary preparations for elective colon and rectal surgery.
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Affiliation(s)
- Anjali S. Kumar
- Section of Colon and Rectal Surgery, Department of Surgery, MedStar Washington Hospital Center, Washington, District of Columbia
- Department of Surgery, Georgetown University, Washington, District of Columbia
| | - Deirdre C. Kelleher
- Section of Colon and Rectal Surgery, Department of Surgery, MedStar Washington Hospital Center, Washington, District of Columbia
- Department of Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York
| | - Gavin W. Sigle
- Section of Colon and Rectal Surgery, Department of Surgery, MedStar Washington Hospital Center, Washington, District of Columbia
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Otchy DP, Crosby ME, Trickey AW. Colectomy without mechanical bowel preparation in the private practice setting. Tech Coloproctol 2013; 18:45-51. [PMID: 23467770 DOI: 10.1007/s10151-013-0990-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 02/11/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND Despite randomized trials and meta-analyses demonstrating the safety of omitting mechanical bowel preparation (MBP) before colorectal surgery, private practice surgeons may hesitate to eliminate MBP for fear of being outside community standards. This study evaluated the safety of eliminating MBP before colectomy in a private practice setting. METHODS This prospective observational study included elective abdominal colorectal operations from one surgeon's practice from October 2008 to June 2011. MBP was not routinely utilized after November 2009. Postoperative 30-day complication rates and length of hospital stay were compared in patients with and without MBP. Multivariable regression models were developed to compare outcomes among study groups, adjusting for demographics, diagnoses, procedures, and year. RESULTS A total of 165 patients were analyzed. Demographics were similar between groups. Laparoscopic procedures were more common in patients without MBP due to increased laparoscopy over time (43 vs. 61 %, p = 0.03). As regards complications, infection rates were similar between groups (MBP 10.5 % vs. no MBP(NMBP) 11.4 %, adj p = 0.57). Patients without MBP had a shorter length of hospital stay (median: 6 vs. 5 days, p = 0.01), but those differences were not statistically significant after adjustment (p = 0.14). CONCLUSIONS Private practice surgeons should embrace evidence-based practice changes and make efforts to quantitatively evaluate the safety of those changes. Omission of MBP for most elective colectomy procedures appears to be safe with no significant increase in complications or length of hospital stay. Because MBP has substantial drawbacks, there is little justification for its routine use in the majority of elective abdominal colorectal procedures.
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Affiliation(s)
- D P Otchy
- Fairfax Colon and Rectal Surgery P.C., 2710 Prosperity Ave., Suite #200, Fairfax, VA, 22031, USA,
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19
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Casagranda B, Cavallin R, de Manzini N. Perioperative Treatment. Updates Surg 2013. [DOI: 10.1007/978-88-470-2670-4_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Lee CM, Lee SH, Ahn BK, Baek SU. The Safety of Elective Colorectal Surgery without Mechanical Bower Preparation. KOSIN MEDICAL JOURNAL 2012. [DOI: 10.7180/kmj.2012.27.2.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives To reduce the risk of postoperative infectious complications and anastomotic leakage in colorectal surgery, preoperative mechanical bowel preparation (MBP) is performed routinely. The aim of this study was to evaluate the safety of primary anastomosis in elective colorectal surgery without MBP. Methods From Jan. 2005 to Dec. 2006, three hundred and seventy-nine patients of elective colorectal surgery with primary anastomosis were performed with MBP in 352 cases (Prep group) and without MBP in 24 cases (Non-prep group). For preoperative MBP, 4 liters of polyethylene glycol solution was administered. Postoperative infectious complications and other morbidity were reviewed with medical records and prospectively collected data. Results Demographic, clinical and treatment characteristics did not differ significantly between the two groups. The overall rate of abdominal infectious complications (wound infection, anastomotic leak) was 2.9 % in the Prep group and 9 % in the Non-prep group (P > 0.05). Anastomotic leak occurred in nine patients (2.6%) in the Prep group and one (4.5%) in the Non-prep group. Conclusions The incidence of infectious complications after elective colorectal surgery without MBP did not differ significantly compare to that with MBP. However, prospective, randomized clinical trial is needed to assess the safety of primary anastomosis in elective colorectal surgery without MBP.
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Scabini S, Rimini E, Romairone E, Scordamaglia R, Damiani G, Pertile D, Ferrando V. Retraction: Colon and rectal surgery for cancer without mechanical bowel preparation: one-center randomized prospective trial. World J Surg Oncol 2012; 10:196. [PMID: 22992274 PMCID: PMC3495656 DOI: 10.1186/1477-7819-10-196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 09/18/2012] [Indexed: 01/11/2023] Open
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Cao F, Li J, Li F. Mechanical bowel preparation for elective colorectal surgery: updated systematic review and meta-analysis. Int J Colorectal Dis 2012; 27:803-10. [PMID: 22108902 DOI: 10.1007/s00384-011-1361-y] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2011] [Indexed: 02/06/2023]
Abstract
PURPOSE Mechanical bowel preparation (MBP) for elective colorectal surgery has been practiced as a clinical routine for many decades. However, earlier randomized clinical trials (RCTs) and meta-analyses suggest that MBP should be abandoned before colorectal surgery because of the futility in reducing postoperative complications and motility. The new published results from three RCTs comparing MBP with no MBP in colorectal surgery in 2010 make the updating of systemic review and meta-analysis necessary. The aim of this study was to estimate efficacy of MBP in prevention of postoperative complications for elective colorectal surgery. METHOD A literature search was performed mainly in electronic database including Cochrane Library, EMBASE, and MEDLINE. The inclusion criteria were randomized clinical trials comparing MBP with no MBP before colorectal surgery. Septic complications, reoperation, and death were recorded as primary and secondary outcomes. The meta-analysis was conducted according to the QUOROM statement. RESULTS Fourteen RCTs were included in our analysis with a total number of 5,373 patients: 2,682 with MBP and 2,691 without. Comparing with no MBP for elective colorectal surgery, our study showed that MBP had not reduce any postoperative complications when concerning anastomotic leak [odds ratio (OR) 95% confidence interval (CI), 1.08 (0.82-1.43); P = 0.56]; overall SSI [OR 95% CI, 1.26 (0.94-1.68); P = 0.12]; extra-abdominal septic complications [OR 95% CI, 0.98 (0.81-1.18); P = 0.81]; wound infections [OR 95% CI, 1.21 (1.00-1.46); P = 0.05]; reoperation or second intervention rate [OR 95% CI, 1.11 (0.86-1.45); P = 0.42]; and death [OR 95% CI, 0.97(0.63-1.48); P = 0.88]. CONCLUSION No evidence was noted supporting the use of MBP in patients undergoing elective colorectal surgery. MBP should be omitted in routine clinical practice.
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Affiliation(s)
- F Cao
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, 100053, Beijing, China
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23
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de Jong MC, van Dam RM, Maas M, Bemelmans MHA, Olde Damink SWM, Beets GL, Dejong CHC. The liver-first approach for synchronous colorectal liver metastasis: a 5-year single-centre experience. HPB (Oxford) 2011; 13:745-52. [PMID: 21929676 PMCID: PMC3210977 DOI: 10.1111/j.1477-2574.2011.00372.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND For patients who present with synchronous colorectal carcinoma and colorectal liver metastasis (CRLM), a reversed treatment sequence in which the CRLM are resected before the primary carcinoma has been proposed (liver-first approach). The aim of the present study was to assess the feasibility and outcome of this approach for synchronous CRLM. METHODS Between 2005 and 2010, 22 patients were planned to undergo the liver-first approach. Feasibility and outcomes were prospectively evaluated. RESULTS Of the 22 patients planned to undergo the liver-first strategy, the approach was completed in 18 patients (81.8%). The main reason for treatment failure was disease progression. Patients who completed treatment and patients who deviated from the protocol had a similar location of the primary tumour, as well as comparable size, number and distribution of CRLM (all P > 0.05). Post-operative morbidity and mortality were 27.3% and 0% following liver resection and 44.4% and 5.6% after colorectal surgery, respectively. On an intention-to-treat-basis, overall 3-year survival was 41.1%. However, 37.5% of patients who completed the treatment had developed recurrent disease at the time of the last follow-up. CONCLUSIONS The liver-first approach is feasible in approximately four-fifths of patients and can be performed with peri-operative mortality and morbidity similar to the traditional treatment paradigm. Patients treated with this novel strategy derive a considerable overall-survival-benefit, although disease-recurrence-rates remain relatively high, necessitating a multidisciplinary approach.
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Affiliation(s)
- Mechteld C de Jong
- Department of Surgery, Maastricht University Medical CentreMaastricht, the Netherlands,NUTRIM – School for Nutrition, Toxicology and Metabolism, Maastricht UniversityMaastricht, the Netherlands
| | - Ronald M van Dam
- Department of Surgery, Maastricht University Medical CentreMaastricht, the Netherlands
| | - Monique Maas
- Department of Surgery, Maastricht University Medical CentreMaastricht, the Netherlands,Department of Radiology, Maastricht University Medical CentreMaastricht, the Netherlands
| | - Marc HA Bemelmans
- Department of Surgery, Maastricht University Medical CentreMaastricht, the Netherlands
| | - Steven WM Olde Damink
- Department of Surgery, Maastricht University Medical CentreMaastricht, the Netherlands
| | - Geerard L Beets
- Department of Surgery, Maastricht University Medical CentreMaastricht, the Netherlands
| | - Cornelis HC Dejong
- Department of Surgery, Maastricht University Medical CentreMaastricht, the Netherlands,NUTRIM – School for Nutrition, Toxicology and Metabolism, Maastricht UniversityMaastricht, the Netherlands
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Güenaga KF, Matos D, Wille-Jørgensen P. Mechanical bowel preparation for elective colorectal surgery. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2011. [PMID: 21901677 DOI: 10.1002/14 651858.cd001544.pub4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The presence of bowel contents during colorectal surgery has been related to anastomotic leakage, but the belief that mechanical bowel preparation (MBP) is an efficient agent against leakage and infectious complications is based on observational data and expert opinions only.An enema before the rectal surgery to clean the rectum and facilitate the manipulation for the mechanical anastomosis is used for many surgeons. This is analysed separately OBJECTIVES To determine the security and effectiveness of MBP on morbidity and mortality in colorectal surgery. SEARCH STRATEGY Publications describing trials of MBP before elective colorectal surgery were sought through searches of MEDLINE, EMBASE, LILACS, IBECS and The Cochrane Library; by handsearching relevant medical journals and conference proceedings, and through personal communication with colleagues.Searches were performed December 1, 2010. SELECTION CRITERIA Randomised controlled trials (RCTs) including participants submitted for elective colorectal surgery. Eligible interventions included any type of MBP compared with no MBP. Primary outcomes included anastomosis leakage - both rectal and colonic - and combined figures. Secondary outcomes included mortality, peritonitis, reoperation, wound infection, extra-abdominal complications, and overall surgical site infections. DATA COLLECTION AND ANALYSIS Data were independently extracted and checked. The methodological quality of each trial was assessed. Details of randomisation, blinding, type of analysis, and number lost to follow up were recorded. For analysis, the Peto-Odds Ratio (OR) was used as the default (no statistical heterogeneity was observed). MAIN RESULTS At this update six trials and a new comparison (Mechanical bowel preparation versus enema) were added. Altogether eighteen trials were analysed, with 5805 participants; 2906 allocated to MBP (Group A), and 2899 to no preparation (Group B), before elective colorectal surgery.For the comparison Mechanical Bowel Preparation Versus No Mechanical Bowel Preparation results were:1. Anastomotic leakage for low anterior resection: 8.8% (38/431) of Group A, compared with 10.3% (43/415) of Group B; Peto OR 0.88 [0.55, 1.40].2. Anastomotic leakage for colonic surgery: 3.0% (47/1559) of Group A, compared with 3.5% (56/1588) of Group B; Peto OR 0.85 [0.58, 1.26].3. Overall anastomotic leakage: 4.4% (101/2275) of Group A, compared with 4.5% (103/2258) of Group B; Peto OR 0.99 [0.74, 1.31].4. Wound infection: 9.6% (223/2305) of Group A, compared with 8.5% (196/2290) of Group B; Peto OR 1.16 [0.95, 1.42].Sensitivity analyses did not produce any differences in overall results.For the comparison Mechanical Bowel Preparation (A) Versus Rectal Enema (B) results were:1. Anastomotic leakage after rectal surgery: 7.4% (8/107) of Group A, compared with 7.9% (7/88) of Group B; Peto OR 0.93 [0.34, 2.52].2. Anastomotic leakage after colonic surgery: 4.0% (11/269) of Group A, compared with 2.0% (6/299) of Group B; Peto OR 2.15 [0.79, 5.84].3. Overall anastomotic leakage: 4.4% (27/601) of Group A, compared with 3.4% (21/609) of Group B; Peto OR 1.32 [0.74, 2.36].4. Wound infection: 9.9% (60/601) of Group A, compared with 8.0% (49/609) of Group B; Peto OR 1.26 [0.85, 1.88]. AUTHORS' CONCLUSIONS Despite the inclusion of more studies with a total of 5805 participants, there is no statistically significant evidence that patients benefit from mechanical bowel preparation, nor the use of rectal enemas. In colonic surgery the bowel cleansing can be safely omitted and induces no lower complication rate. The few studies focused in rectal surgery suggested that mechanical bowel preparation could be used selectively, even though no significant effect was found. Further research on patients submitted for elective rectal surgery, below the peritoneal verge, in whom bowel continuity is restored, and studies with patients submitted to laparoscopic surgeries are still warranted.
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Affiliation(s)
- Katia F Güenaga
- Rua Ministro João Mendes, 60/31, Santos, São Paulo, Brazil, 11040-260
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25
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Abstract
BACKGROUND The presence of bowel contents during colorectal surgery has been related to anastomotic leakage, but the belief that mechanical bowel preparation (MBP) is an efficient agent against leakage and infectious complications is based on observational data and expert opinions only.An enema before the rectal surgery to clean the rectum and facilitate the manipulation for the mechanical anastomosis is used for many surgeons. This is analysed separately OBJECTIVES To determine the security and effectiveness of MBP on morbidity and mortality in colorectal surgery. SEARCH STRATEGY Publications describing trials of MBP before elective colorectal surgery were sought through searches of MEDLINE, EMBASE, LILACS, IBECS and The Cochrane Library; by handsearching relevant medical journals and conference proceedings, and through personal communication with colleagues.Searches were performed December 1, 2010. SELECTION CRITERIA Randomised controlled trials (RCTs) including participants submitted for elective colorectal surgery. Eligible interventions included any type of MBP compared with no MBP. Primary outcomes included anastomosis leakage - both rectal and colonic - and combined figures. Secondary outcomes included mortality, peritonitis, reoperation, wound infection, extra-abdominal complications, and overall surgical site infections. DATA COLLECTION AND ANALYSIS Data were independently extracted and checked. The methodological quality of each trial was assessed. Details of randomisation, blinding, type of analysis, and number lost to follow up were recorded. For analysis, the Peto-Odds Ratio (OR) was used as the default (no statistical heterogeneity was observed). MAIN RESULTS At this update six trials and a new comparison (Mechanical bowel preparation versus enema) were added. Altogether eighteen trials were analysed, with 5805 participants; 2906 allocated to MBP (Group A), and 2899 to no preparation (Group B), before elective colorectal surgery.For the comparison Mechanical Bowel Preparation Versus No Mechanical Bowel Preparation results were:1. Anastomotic leakage for low anterior resection: 8.8% (38/431) of Group A, compared with 10.3% (43/415) of Group B; Peto OR 0.88 [0.55, 1.40].2. Anastomotic leakage for colonic surgery: 3.0% (47/1559) of Group A, compared with 3.5% (56/1588) of Group B; Peto OR 0.85 [0.58, 1.26].3. Overall anastomotic leakage: 4.4% (101/2275) of Group A, compared with 4.5% (103/2258) of Group B; Peto OR 0.99 [0.74, 1.31].4. Wound infection: 9.6% (223/2305) of Group A, compared with 8.5% (196/2290) of Group B; Peto OR 1.16 [0.95, 1.42].Sensitivity analyses did not produce any differences in overall results.For the comparison Mechanical Bowel Preparation (A) Versus Rectal Enema (B) results were:1. Anastomotic leakage after rectal surgery: 7.4% (8/107) of Group A, compared with 7.9% (7/88) of Group B; Peto OR 0.93 [0.34, 2.52].2. Anastomotic leakage after colonic surgery: 4.0% (11/269) of Group A, compared with 2.0% (6/299) of Group B; Peto OR 2.15 [0.79, 5.84].3. Overall anastomotic leakage: 4.4% (27/601) of Group A, compared with 3.4% (21/609) of Group B; Peto OR 1.32 [0.74, 2.36].4. Wound infection: 9.9% (60/601) of Group A, compared with 8.0% (49/609) of Group B; Peto OR 1.26 [0.85, 1.88]. AUTHORS' CONCLUSIONS Despite the inclusion of more studies with a total of 5805 participants, there is no statistically significant evidence that patients benefit from mechanical bowel preparation, nor the use of rectal enemas. In colonic surgery the bowel cleansing can be safely omitted and induces no lower complication rate. The few studies focused in rectal surgery suggested that mechanical bowel preparation could be used selectively, even though no significant effect was found. Further research on patients submitted for elective rectal surgery, below the peritoneal verge, in whom bowel continuity is restored, and studies with patients submitted to laparoscopic surgeries are still warranted.
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Affiliation(s)
- Katia F Güenaga
- Rua Ministro João Mendes, 60/31SantosSão PauloBrazil11040‐260
| | - Delcio Matos
- UNIFESP ‐ Escola Paulista de MedicinaGastroenterological SurgeryRua Edison 278, Apto 61, Campo BeloSão PauloSão PauloBrazil04618‐031
| | - Peer Wille‐Jørgensen
- Bispebjerg HospitalDepartment of Surgical Gastroenterology KBispebjerg Bakke 23Copenhagen NVDenmarkDK‐2400
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Abraham N, Albayati S. Enhanced recovery after surgery programs hasten recovery after colorectal resections. World J Gastrointest Surg 2011; 3:1-6. [PMID: 21286218 PMCID: PMC3030737 DOI: 10.4240/wjgs.v3.i1.1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 01/16/2011] [Accepted: 01/23/2011] [Indexed: 02/06/2023] Open
Abstract
Colorectal resection was traditionally associated with significant morbidity and prolonged stay in hospital. Laparoscopic colorectal resection was first described in 1991 as a minimally invasive form of colorectal surgery. It was later on assessed by multiple randomized controlled trials and meta-analysis and was found to be associated with a faster recovery, lower complication rates and a shorter stay in hospital compared with open resection. To assess the effect of enhanced recovery after surgery (ERAS) program on postoperative length of stay after elective colorectal resections, a literature review was conducted, supplemented by the results of 111 ERAS colorectal resections at regional NWS Hospital using a protocol based on the Fast Track approach described by Kehlet in 1999. ERAS has been shown to improve postoperative recovery, reduce length of stay and enhance early return to normal function when compared with traditional colorectal surgical protocols. The role of laparoscopic surgery in colorectal resections within a fast-track (ERAS) program is controversial. The current evidence suggests that within such a program, there is no difference between laparoscopic and open colorectal surgery in terms of postoperative recovery rates or length of hospital stay.
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Affiliation(s)
- Ned Abraham
- Ned Abraham, Sinan Albayati, Coffs Harbour Campus, Faculty of Medicine, University of New South Wales, Colorectal and General Surgeon and Endoscopist, Coffs Colorectal and Capsule Endoscopy Centre, 187 Rose Avenue, Po Box 2244, Coffs Harbour, NSW 2450, Australia
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Fritze D, Englesbe MJ, Campbell DA. Oral antibiotics to prevent surgical site infections following colon surgery. Adv Surg 2011; 45:141-153. [PMID: 21954684 DOI: 10.1016/j.yasu.2011.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Danielle Fritze
- Department of Surgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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Allen G. Evidence for Practice. AORN J 2010. [DOI: 10.1016/j.aorn.2010.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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