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Orthograde Darmlavage mit/ohne orale Antibiose

Aktuelle Evidenz

Orthograde bowel lavage with or without oral antibiotics

Current evidence

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Zusammenfassung

Kolorektale Operationen gehören zu den häufigsten viszeralchirurgischen Eingriffen und sind mit einem erhöhten Risiko für infektiöse Komplikationen verbunden. Eine präoperative Darmvorbereitung soll dazu beitragen, das Risiko für derartige Komplikationen zu verringern. Zu diesem Zweck werden u. a. Methoden wie die orthograde Darmlavage zur Verringerung der fäkalen Kontamination, die Verabreichung oraler Antibiotika zur Verringerung der bakteriellen Besiedlung der Schleimhaut oder eine Kombination aus mechanischer Spülung und oralen Antibiotika eingesetzt. Es herrscht jedoch Uneinigkeit darüber, welche Methode zur präoperativen Darmvorbereitung am wirksamsten ist. Für die rein mechanische Darmvorbereitung konnte im Rahmen einer Cochrane-Analyse kein positiver Effekt nachgewiesen werden. Eine Kombination aus mechanischer Spülung und oralen Antibiotika verringert hingegen das Risiko für Wundinfektionen und Anastomoseninsuffizienzen. Ob eine alleinige oral-antibiotische Darmvorbereitung ohne zusätzliche mechanische Darmspülung den gleichen Effekt erzielen kann und somit auf eine mechanische Spülung verzichtet werden kann, bleibt angesichts der aktuellen Evidenz fraglich.

Abstract

Colorectal surgery is one of the most common visceral surgical procedures and is associated with an increased risk of infectious complications. Preoperative bowel preparation is intended to help reduce the risk of such complications. To this end, methods used include orthograde bowel lavage to reduce fecal contamination, the administration of oral antibiotics to reduce bacterial colonization of the mucosa or a combination of mechanical irrigation and oral antibiotics; however, there is disagreement as to which method is most effective for preoperative bowel preparation. Within the framework of a Cochrane analysis no positive effect could be demonstrated for purely mechanical bowel preparation; however, a combination of mechanical irrigation and oral antibiotics reduces the risk of wound infections and anastomotic insufficiency. Whether oral antibiotic bowel preparation alone without additional mechanical bowel irrigation can achieve the same effect and thus mechanical irrigation can be dispensed with, remains questionable in view of the current evidence.

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Authors and Affiliations

  1. Klinik und Poliklinik für Allgemein‑, Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Gebäude 22, Venusberg Campus 1, 53127, Bonn, Deutschland

    Maria A. Willis, Lucrezia De Santis, Jörg C. Kalff & Tim O. Vilz

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  1. Maria A. Willis
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  2. Lucrezia De Santis
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  3. Jörg C. Kalff
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  4. Tim O. Vilz
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Correspondence to Maria A. Willis.

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M.A. Willis, L.D. Santis, J.C. Kalff und T.O. Vilz geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Willis, M.A., Santis, L.D., Kalff, J.C. et al. Orthograde Darmlavage mit/ohne orale Antibiose. coloproctology 45, 362–367 (2023). https://doi.org/10.1007/s00053-023-00743-z

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