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The value of mechanical bowel preparation prior to pediatric colorectal surgery: a systematic review and meta-analysis

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Abstract

Purpose

The use of mechanical bowel preparation (MBP) before pediatric colorectal surgery remains the standard of care for many pediatric surgeons, though the value of MBP remains unclear. The aim of this study was to systematically review and analyze the effect of MBP on the incidence of postoperative complications; anastomotic leakage, intra-abdominal infection, and wound infection, following colorectal surgery in pediatric patients.

Methods

Embase, MEDLINE, Web of Science, and CINAHL databases were searched to compare the effect of MBP versus no MBP prior to elective pediatric colorectal surgery on postoperative complications. After critical appraisal of included studies, meta-analyses were conducted using a random-effect model.

Results

1731 papers were retrieved; 2 randomized controlled trials and 4 retrospective cohort studies met the inclusion criteria. The overall quality of evidence was low. MBP before colorectal surgery did not significantly decrease the occurrence of anastomotic leakage, intra-abdominal infection, or wound infection compared to no MBP.

Conclusions

On the basis of the existing evidence, the use of MBP before colorectal surgery in children seems not to decrease the incidence of postoperative complications compared to no MBP. To overcome confounding factors such as antibiotic prophylaxis, age and type of operation, a multicentre prospective study is suggested to validate these results.

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Acknowledgements

Dr. Agostino Pierro was supported by the endowment of the Robert M. Filler Chair of Surgery and The Hospital for Sick Children.

Funding

Robert M. Filler Chair of Surgery, the Hospital for Sick Children. The authors have no financial relationships relevant to disclose.

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Authors and Affiliations

  1. Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

    Maarten Janssen Lok, Hiromu Miyake, Joshua S. O’Connell, Shogo Seo & Agostino Pierro

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  1. Maarten Janssen Lok
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Janssen Lok, M., Miyake, H., O’Connell, J.S. et al. The value of mechanical bowel preparation prior to pediatric colorectal surgery: a systematic review and meta-analysis. Pediatr Surg Int 34, 1305–1320 (2018). https://doi.org/10.1007/s00383-018-4345-y

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