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Oral antibiotics and a low-residue diet reduce the incidence of anastomotic leakage after left-sided colorectal surgery: a retrospective cohort study

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Abstract

Purpose

Anastomotic leakage is a potential complication after colorectal surgery. We investigated the effects of oral antibiotics and a low-residue diet on the incidence of anastomotic leakage after left-sided colorectal surgery.

Methods

Outcomes were retrospectively compared between 64 patients who underwent mechanical bowel preparation alone (group A) and 183 patients who underwent mechanical bowel preparation with addition of oral kanamycin and metronidazole (group B) on the day before left-sided colorectal surgery. After surgery, patients in group A received a normal diet containing dietary fiber and those in group B received a low-residue diet. The primary outcome was the incidence of anastomotic leakage. Secondary outcomes were rates of other postoperative complications, length of postoperative hospital stay, and laboratory data.

Results

Anastomotic leakage, surgical site infection, and diarrhea were less common in group B than in group A (4.9% vs 18.8%, 6.6% vs 23.4%, and 25.7% vs 43.8%, respectively). Postoperative C-reactive protein levels were significantly lower in group B. The median postoperative hospital stay was significantly shorter in group B than in group A (8 days vs 9 days, P = 0.010). Adaptive double least absolute shrinkage and selection operator regression revealed that use of preoperative oral antibiotics and a postoperative low-residue diet were associated with lower incidence of anastomotic leakage (odds ratio 0.163, 95% confidence interval 0.062–0.430; P < 0.001).

Conclusion

Oral antibiotics and a low-residue diet reduced the incidence of anastomotic leakage and shortened the postoperative hospital stay by 1 day.

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Data availability

The data that support the finding of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors thank the staff in the Division of Pharmacy and the Department of Esophageal-Gastro-Intestinal Surgery at Chiba University Hospital for their assistance with this research.

Author information

Authors and Affiliations

  1. Division of Pharmacy, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8677, Japan

    Takafumi Nakazawa, Masashi Uchida, Takaaki Suzuki, Kohei Yamamoto, Kaori Yamazaki, Takako Nakamura & Itsuko Ishii

  2. Graduate School of Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8675, Japan

    Takafumi Nakazawa, Masashi Uchida, Takaaki Suzuki & Itsuko Ishii

  3. Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8677, Japan

    Tetsuro Maruyama, Hideaki Miyauchi & Hisahiro Matsubara

  4. Department of Clinical Nutrition, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8677, Japan

    Yuta Tsuruoka

  5. Biostatics Section, Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8677, Japan

    Yuki Shiko

  6. Faculty of Nursing, Japanese Red Cross College of Nursing, 4-1-3 Hiroo, Shibuya-ku, Tokyo, 150-0012, Japan

    Yohei Kawasaki

Authors
  1. Takafumi Nakazawa
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  2. Masashi Uchida
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  3. Takaaki Suzuki
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  11. Yohei Kawasaki
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Contributions

TN, MU, and TS: study conceptualization and design, data interpretation and analysis, manuscript writing and revision; KY and KY: study design, data interpretation, manuscript revision; TM and HM: study design, data acquisition and interpretation, manuscript revision; TN and HM: data interpretation, manuscript revision; YS and YK: data analysis; II: supervision, study conceptualization and design, data interpretation and analysis, manuscript revision. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Takaaki Suzuki.

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The study was approved by the Ethical Committee of Chiba University School of Medicine (approval number 4056) and conducted in compliance with the Ethical Guidelines for Medical Research Involving Human Subjects.

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The authors declare no competing interests.

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Nakazawa, T., Uchida, M., Suzuki, T. et al. Oral antibiotics and a low-residue diet reduce the incidence of anastomotic leakage after left-sided colorectal surgery: a retrospective cohort study. Langenbecks Arch Surg 407, 2471–2480 (2022). https://doi.org/10.1007/s00423-022-02574-w

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