Skip to main content
SpringerLink
Log in

Laparoscopic colon resection: To prep or not to prep? Analysis of 1535 patients

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Mechanical bowel preparation (MBP) before elective open colon resection does not reduce the rate of postoperative anastomotic leakage. However, MBP is still routinely used in many countries, and there are very limited data regarding the utility of preoperative MBP in patients undergoing laparoscopic colon resection (LCR). The aim of this study was to challenge the use of MBP before elective LCR.

Methods

It is a retrospective analysis of a prospectively collected database. All patients undergoing elective LCR with primary anastomosis and no stoma were included. Preoperative MBP with polyethylene glycol solution was used routinely between April 1992 and December 2004, and then it was abandoned. The early postoperative outcomes in patients who had preoperative MBP (MBP group) and in patients who underwent LCR without preoperative MBP (No-MBP group) were compared.

Results

From April 1992 to December 2014, 1535 patients underwent LCR: 706 MBP patients and 829 No-MBP patients. There were no differences in demographic data, indication for surgery and type of procedure performed between MBP and No-MBP group patients. The incidence of anastomotic leakage was similar between the two groups (3.4 vs. 3.6 %, p = 0.925). No differences were observed in intra-abdominal abscesses (0.6 vs. 0.8 %, p = 0.734), wound infections (0.6 vs. 1.4 %, p = 0.149), infectious extra-abdominal complications (1.8 vs. 3 %, p = 0.190), and non-infectious complications (6.1 vs. 6.8 %, p = 0.672). The overall reoperation rate was 4.6 % for MBP patients and 5 % for No-MBP patients (p = 0.813).

Conclusion

The use of preoperative MBP does not seem to be associated with lower incidence of intra-abdominal septic complications after LCR.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Nichols RL, Condon RE (1971) Preoperative preparation of the colon. Surg Gynecol Obstet 132:323–337

    CAS  PubMed  Google Scholar 

  2. Burke P, Mealy K, Gillen P, Joyce W, Traynor O, Hyland J (1994) Requirement for bowel preparation in colorectal surgery. Br J Surg 81:907–910

    Article  CAS  PubMed  Google Scholar 

  3. Santos JC Jr, Batista J, Sirimarco MT, Guimarães AS, Levy CE (1994) Prospective randomized trial of mechanical bowel preparation in patients undergoing elective colorectal surgery. Br J Surg 81:1673–1676

    Article  PubMed  Google Scholar 

  4. Kale TI, Kuzu MA, Tekeli A, Tanik A, Aksoy M, Cete M (1998) Aggressive bowel preparation does not enhance bacterial translocation, provided the mucosal barrier is not disrupted. A prospective, randomized study. Dis Colon Rectum 41:636–641

    Article  CAS  PubMed  Google Scholar 

  5. Miettinen RP, Laitinen ST, Mäkelä JT, Pääkkönen ME (2000) Bowel preparation with oral colorectal surgery: prospective, randomized study. Dis Colon Rectum 43:669–677

    Article  CAS  PubMed  Google Scholar 

  6. Young TF, Celis ZJ, Berrospi EF, Payet ME, Ruiz FE (2002) Mechanical preparation in elective colorectal surgery, a usual practice or a necessity? Rev Gastroenterol Peru 22:152–158

    Google Scholar 

  7. Zmora O, Mahajna A, Bar-Zakai B, Rosin D, Hershko D, Shabtai M, Krausz MM, Ayalon A (2003) Colon and rectal surgery without mechanical bowel preparation: a randomized prospective trial. Ann Surg 237:363–367

    PubMed  PubMed Central  Google Scholar 

  8. Fa-Si-Oen P, Roumen R, Buitenweg J, van de Velde C, van Geldere D, Putter H, Verwaest C, Verhoef L, de Waard JW, Swank D, D’Hoore A, van Uchelen FC (2005) Mechanical bowel preparation or not? Outcome of a multicenter, randomized trial in elective open colon surgery. Dis Colon Rectum 48:1509–1516

    Article  PubMed  Google Scholar 

  9. Bucher P, Gervaz P, Soravia C, Mermillod B, Erne M, Morel P (2005) Randomized clinical trial of mechanical bowel preparation versus no preparation before elective left-sided colorectal surgery. Br J Surg 92:409–414

    Article  CAS  PubMed  Google Scholar 

  10. Ram E, Sherman Y, Weil R, Vishne T, Kravarusic D, Dreznik Z (2005) Is mechanical bowel preparation mandatory for elective colon surgery? A prospective randomized study. Arch Surg 140:285–288

    Article  PubMed  Google Scholar 

  11. Pena-Soria MJ, Mayol JM, Anula-Fernadez R, Arbeo-Escolar A, Fernandez-Represa JA (2007) Mechanical bowel preparation for elective colorectal surgery with primary intraperitioneal anastomosis by a single surgeon: interim analysis of a prospective single-blinded randomized trial. J Gastrointest Surg 11:562–567

    Article  PubMed  Google Scholar 

  12. Jung B, Påhlman L, Nystrom PO, Nilsson E, Mechanical Bowel Preparation Study Group (2007) Multicentre randomized clinical trial of mechanical bowel preparation in elective colonic resection. Br J Surg 94:689–695

    Article  CAS  PubMed  Google Scholar 

  13. Contant CM, Hop WC, van’t Sant HP, Oostvogel HJ, Smeets HJ, Stassen LP, Neijenhuis PA, Idenburg FJ, Dijkhuis CM, Heres P, van Tets WF, Gerritsen JJ, Weidema WF (2007) Mechanical bowel preparation for elective colorectal surgery: a multicentre randomised trial. Lancet 370:2112–2117

    Article  PubMed  Google Scholar 

  14. Slim K, Vicaut E, Launay-Savary MV, Contant C, Chipponi J (2009) Updated systematic review and meta-analysis of randomized clinical trials on the role of mechanical bowel preparation before colorectal surgery. Ann Surg 249:203–209

    Article  PubMed  Google Scholar 

  15. Roig JV, García-Fadrique A, García-Armengol J, Bruna M, Redondo C, García-Coret MJ, Albors P (2009) Mechanical bowel preparation and antibiotic prophylaxis in colorectal surgery: use by and opinions of Spanish surgeons. Colorectal Dis 11:44–48

    Article  CAS  PubMed  Google Scholar 

  16. Drummond RJ, McKenna RM, Wright DM (2011) Current practice in bowel preparation for colorectal surgery: a survey of the members of the Association of Coloproctology of GB & Ireland. Colorectal Dis 13:708–710

    Article  CAS  PubMed  Google Scholar 

  17. Kahokehr A, Robertson P, Sammour T, Soop M, Hill AG (2011) Perioperative care: a survey of New Zealand and Australian colorectal surgeons. Colorectal Dis 13:1308–1313

    Article  CAS  PubMed  Google Scholar 

  18. Marchaim D, Slim J, Dhar S, Flanagan E, Chopra T, Farber M, Weaver D, Kaye KS (2011) A regional survey of the use of mechanical bowel preparations prior to colorectal surgery. Ann Surg 253:839

    Article  PubMed  Google Scholar 

  19. Slieker JC, van’t Sant HP, Vlot J, Daams F, Jansen FW, Lange JF (2011) Bowel preparation prior to laparoscopic colorectal resection: What is the current practice? J Laparoendosc Adv Surg Tech A 21:899–903

    Article  PubMed  Google Scholar 

  20. Zerey M, Hawver LM, Awad Z, Stefanidis D, Richardson W, Fanelli RD, Members of the SAGES Guidelines Committee (2013) SAGES evidence-based guidelines for the laparoscopic resection of curable colon and rectal cancer. Surg Endosc 27:1–10

    Article  PubMed  Google Scholar 

  21. Pirró N, Ouaissi M, Sielezneff I, Fakhro A, Pieyre A, Consentino B, Sastre B (2006) Feasibility of colorectal surgery without colonic preparation. A prospective study. Ann Chir 131:442–446

    Article  PubMed  Google Scholar 

  22. Zmora O, Lebedyev A, Hoffman A, Khaikin M, Munz Y, Shabtai M, Ayalon A, Rosin D (2006) Laparoscopic colectomy without mechanical bowel preparation. Int J Colorectal Dis 21:683–687

    Article  PubMed  Google Scholar 

  23. Slim K, Vicaut E, Panis Y, Chipponi J (2004) Meta-analysis of randomized clinical trials of colorectal surgery with or without mechanical bowel preparation. Br J Surg 91:1125–1130

    Article  CAS  PubMed  Google Scholar 

  24. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications. A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  25. Watanabe M, Murakami M, Nakao K, Asahara T, Nomoto K, Tsunoda A (2010) Randomized clinical trial of the influence of mechanical bowel preparation on faecal microflora in patients undergoing colonic cancer resection. Br J Surg 97:1791–1797

    Article  CAS  PubMed  Google Scholar 

  26. Jung B, Matthiessen P, Smedh K, Nilsson E, Ransjö U, Påhlman L (2009) Mechanical bowel preparation does not affect the intramucosal bacterial colony count. Int J Colorectal Dis 25:439–442

    Article  PubMed  Google Scholar 

  27. Gorgun IE, Aytac E, Manilich E, Church JM, Remzi FH (2013) Intraoperative colonoscopy does not worsen the outcomes of laparoscopic colorectal surgery: a case-matched study. Surg Endosc 27:3572–3576

    Article  PubMed  Google Scholar 

  28. Kim SH, Milsom JW, Church JM, Ludwig KA, Garcia-Ruiz A, Okuda J, Fazio VW (1997) Perioperative tumor localization for laparoscopic colorectal surgery. Surg Endosc 11:1013–1016

    Article  CAS  PubMed  Google Scholar 

  29. Cho YB, Lee WY, Yun HR, Lee WS, Yun SH, Chun HK (2007) Tumor localization for laparoscopic colorectal surgery. World J Surg 31:1491–1495

    Article  PubMed  Google Scholar 

  30. Park JW, Sohn DK, Hong CW, Han KS, Choi DH, Chang HJ, Lim SB, Choi HS, Jeong SY (2008) The usefulness of preoperative colonoscopic tattooing using a saline test injection method with prepackaged sterile India ink for localization in laparoscopic colorectal surgery. Surg Endosc 22:501–505

    Article  CAS  PubMed  Google Scholar 

  31. Yeung JM, Maxwell-Armstrong C, Acheson AG (2009) Colonic tattooing in laparoscopic surgery—making the mark? Colorectal Dis 11(5):527–530

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgical Sciences, University of Torino, Corso A. M. Dogliotti, 14, 10126, Turin, Italy

    Marco Ettore Allaix, Simone Arolfo, Maurizio Degiuli, Giuseppe Giraudo, Silvio Volpatto & Mario Morino

Authors
  1. Marco Ettore Allaix
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Simone Arolfo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maurizio Degiuli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giuseppe Giraudo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Silvio Volpatto
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mario Morino
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marco Ettore Allaix.

Ethics declarations

Disclosures

Drs. Marco Ettore Allaix, Simone Arolfo, Maurizio Degiuli, Giuseppe Giraudo, Silvio Volpatto, and Mario Morino have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Allaix, M.E., Arolfo, S., Degiuli, M. et al. Laparoscopic colon resection: To prep or not to prep? Analysis of 1535 patients. Surg Endosc 30, 2523–2529 (2016). https://doi.org/10.1007/s00464-015-4515-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-015-4515-0

Keywords

Search

Navigation