Abstract
The necessity of preoperative or intraoperative mechanical bowel preparation of the colon, before primary anastomosis, has been recently challenged in clinical elective and emergency situations. PURPOSE: This experimental study in dogs investigated the safety of segmental resection and primary anastomosis in the unprepared or loaded colon. METHODS: Two segments of the descended colon were resected and anastomosed in each animal. Group I (12 anastomoses) received preoperative mechanical bowel preparation; the colon was not prepared in Group II (16 anastomoses); in Group III (12 anastomoses), a preliminary distal colonic obstruction was produced, and during the subsequent resection the colon was loaded. Postoperatively, animals were observed clinically, and anastomoses were assessed at autopsy on the ninth day. RESULTS: All animals recovered uneventfully. At autopsy there was no evidence of anastomotic leakage. CONCLUSIONS: In light of recent clinical reports and this experimental study, the ritual of mechanical bowel preparation should be further scrutinized.
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References
Irving AD, Scrimgeour D. Mechanical bowel preparation for colonic resection and anastomosis. Br J Surg 1987;74:580–1.
Brownson P, Jenkins SA, Nott D, Ellenbogen S. Mechanical bowel preparation before colorectal surgery: results of a prospective randomized trial. Br J Surg 1992;79:461–2.
Irvin TT, Goligher JC. Aetiology of disruption of intestinal anastomoses. Br J Surg 1973;60:461–4.
Solia JA, Rothenberger DA. Preoperative bowel preparation. Dis Colon Rectum 1990;33:154–9.
Saadia R, Schein M. Intraoperative colonic lavage. Dis Colon Rectum 1989;32:78–81.
MacKenzie S, Thomson SR, Baker LW. Management options in malignant obstruction of the left colon. Surg Gynecol Obstet 1992;174:337–45.
Baker LW, Thomson SR. The current status of the management of civilian injuries to the colon. In: Nyhus EL, ed. Surgery annual. Boston: Appeleton Lange, 1991:203–22.
Burch JM, Martin RR, Richardson RJ, Muldowny DS, Mattox KL, Jordan GL. Evolution of the treatment of the injured colon in the 1980's. Arch Surg 1991;126:979–84.
Baker LW, Thomson SR, Chadwick SJ. Colon wound management and prograde colonic lavage in large bowel trauma. Br J Surg 1990;77:872–6.
Dorudi S, Wilson NM, Heddle RM. Primary restorative colectomy in malignant left sided large bowel obstruction. Ann R Coll Surg Engl 1990;72:393–5.
Mealy K, Salman A, Arthur G. Definitive one stage emergency large bowel surgery. Br J Surg 1988;75:1216–9.
Johnston D. Bowel preparation for colorectal surgery. Br J Surg 1987;47:553–4.
Brownson P, Jenkins SA, Nott D, Ellenbogen S. Mechanical bowel preparation before colorectal surgery: results of a prospective randomized trial. Br J Surg 1992;79:461–2.
Atik M, Castleberry JW, Werner JC, Cohn I. An experimental study of primary anastomosis of the obstructed colon. Surg Gynecol Obstet 1960;110:697–701.
Ravo B, Metwally N, Castera P, Polansky PJ, Ger R. The importance of intraluminal anastomotic fecal contact and peritonitis in colonic anastomotic leakages: an experimental study. Dis Colon Rectum 1988;31:868–71.
Smith SR, Connolly JC, Gilmore OJ. The effect of faecal loading on colonic anastomosis healing. Br J Surg 1983;70:49–50.
Hendriks T, Mastboom WJ. Healing of experimental intestinal anastomoses: parameters for repair. Dis Colon Rectum 1990;33:891–901.
Khoury GA, Waxman BP. Large bowel anastomosis: the healing process and sutured anastomoses. Br J Surg 1983;70:61–3.
Alanis A, Papanicolau GK, Tadros RR, Fiedling LP. Primary resection and anastomosis for treatment of acute diverticulitis. Dis Colon Rectum 1989;32:933–9.
References
Solla JA, Rothenberger DA. Preoperative bowel preparation: a survey of colon and rectal surgeons. Dis Colon Rectum 1990;33:154–9.
Nichols RL, Condon RE. Preoperative preparation of the colon. Surg Gynecol Obstet 1971;132:323–37.
Ryan P. The effect of surrounding infection upon the leaking of colonic wounds: experimental studies and clinical experiences. Dis Colon Rectum 1970;13:124–6.
Smith RG, Connolly JC, Gilmore OJ. The effect of faecal loading on colonic anastomotic healing. Br J Surg 1983;70:49–50.
Irving AD, Scrimgeour D. Mechanical bowel preparation for colonic resection and anastomosis. Br J Surg 1987;74:580–1.
Brownson P, Jenkins SA, Nott D, Ellenbogen S. Mechanical bowel preparation before colorectal surgery: results of a prospective randomized trial. Br J Surg 1992;79:461–2.
Santos JC Jr, Batista J, Sirimarco MT, Guimaraes AS, Levy CE. Prospective randomized trial of mechanical bowel preparation in patients undergoing elective colorectal surgery. Br J Surg 1994;81:1673–6.
Nichols RL, Gorbach SL, Condon RE. Alteration of intestinal microflora following preoperative mechanical preparation of the colon. Dis Colon Rectum 1971;14:123–7.
Nichols RL, Condon RE, Gorbach SL, Nyhus LM. Efficacy of preoperative antimicrobial preparation of the bowel. Ann Surg 1972;176:227–32.
Nichols RL. Bowel preparation. In: Meakins JL, ed. Surgical infections diagnosis and treatment. New York: Scientific America, 1994:151–61.
Culver DH, Horan TC, Gaynes RP,et al. The National Nosocomial Infections Surveillance System. Surgical wound infection rates by wound class, operative procedure, and patient risk index. Am J Med 1991;91(Suppl 3B):152S.
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Schein, M., Assalia, A., Eldar, S. et al. Is mechanical bowel preparation necessary before primary colonic anastomosis?. Dis Colon Rectum 38, 749–754 (1995). https://doi.org/10.1007/BF02048035
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DOI: https://doi.org/10.1007/BF02048035