Skip to main content

Advertisement

SpringerLink
Log in

Mechanical Bowel Preparation for Elective Colorectal Surgery with Primary Intraperitoneal Anastomosis by a Single Surgeon: Interim Analysis of a Prospective Single-Blinded Randomized Trial

  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

We report an interim analysis of a prospective single-blinded randomized trial designed to investigate whether preoperative mechanical bowel preparation influences the rate of surgical-site infection and anastomotic failure after elective colorectal surgery with primary intraperitoneal anastomosis performed by a single surgeon. Patients scheduled to undergo an elective colorectal procedure with a primary intraperitoneal anastomosis were randomized to receive either oral polyethylene glycol lavage solution and enemas (group A) or no preparation (group B). Surgical-site infection and anastomotic failure were investigated. Of 97 patients included, 48 were assigned to group A and 49 to group B. Twelve (12.4%) developed wound infections, six in each group (12.5 vs. 12.2%; NS). Intra-abdominal sepsis was only seen in group A (n = 3, 6.3%). Anastomotic failure occurred in four patients in group A (8.3%) vs. two patients in group B (4.1%) (NS). The overall complication rate in group A was 27.1%, vs. 16.3% in group B. The number needed to harm was 9.3. Our interim analysis of a prospective single-blinded randomized trial suggests that a surgeon may have the same or even worse outcomes when mechanical bowel preparation is routinely used for colorectal surgery with primary intraperitoneal anastomosis.

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

Figure 1

Similar content being viewed by others

References

  1. Nichols RL, Choe EU, Weldon CB. Mechanical and antibacterial bowel preparation in colon and rectal surgery. Chemotherapy 2005;51(Suppl 1):115–121.

    Article  PubMed  CAS  Google Scholar 

  2. Smith SR, Connolly JC, Gilmore JA. The effect of fecal loading on colonic anastomosis healing. Br J Surg 1983;70:49–50.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  4. Santos J, Batista J, Sirimarco M, Guimaraes A, Levy C. Prospective randomized trial of mechanical bowel preparation in patients undergoing elective colorectal surgery. Br J Surg 1994;81:1673–1676.

    Article  PubMed  Google Scholar 

  5. Miettinen RP, Laitinen ST, Makela JT, Paakkonen ME. Bowel preparation with oral polyethylene glycol electrolyte solution vs. no preparation in elective open colorectal surgery: prospective, randomized study. Dis Colon Rectum 2000;43:669–675.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  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, Croiset van Uchelen F. Mechanical bowel preparation or not? Outcome of a multicenter, randomized trial in elective open colon surgery. Dis Colon Rectum 2005;48:1509–1516.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  10. Wille-Jorgensen P, Guenaga KF, Matos D, Castro AA. Pre-operative mechanical bowel cleansing or not? An updated meta-analysis. Colorectal Dis 2005;7:304–310.

    Article  PubMed  CAS  Google Scholar 

  11. Zmora O, Pikarsky AJ, Wexner SD. Bowel preparation for colorectal surgery. Dis Colon Rectum 2001;44:1537–1549.

    Article  PubMed  CAS  Google Scholar 

  12. Wille-Jorgensen P, Guenaga KF, Castro AA, Matos D. Clinical value of preoperative mechanical bowel cleansing: A systematic review. Dis Colon Rectum 2003;46:1013–1020.

    Article  PubMed  Google Scholar 

  13. Beck D, Fazio V. Current preoperative bowel cleansing methods. Results of a survey. Dis Colon Rectum 1990;33:12–15.

    Article  PubMed  CAS  Google Scholar 

  14. Zmora O, Wexner SD, Hajjar L, Park T, Efron JE, Nogueras JJ, Weiss EG. Trends in preparation for colorectal surgery: survey of the members of the American Society of Colon and Rectal Surgeons. Am Surg 2003;69:150–154.

    PubMed  Google Scholar 

  15. Otchy D, Hyman NH, Simmang C, Anthony T, Buie WD, Cataldo P, Church J, Cohen J, Dentsman F, Ellis CN, Kilkenny JW 3rd, Ko C, Moore R, Orsay C, Place R, Rafferty J, Rakinic J, Savoca P, Tjandra J, Whiteford M, Standards Practice Task Force, American Society of Colon and Rectal Surgeons. Practice parameters for colon cancer. Dis Colon Rectum 2004;47:1269–1284.

    Article  PubMed  Google Scholar 

  16. Association of Coloproctology of Great Britain and Ireland. Guidelines for the management of colorectal cancer. http://acpgbi.co.uk. 2001.

  17. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 1999;27:97–132.

    Article  PubMed  CAS  Google Scholar 

  18. Smith RL, Bohl JK, McElearny ST, Barclay MM, Swayer RG, Foley EF. Wound infection after elective colorectal resection. Ann Surg 2004;239:599–607.

    Article  PubMed  Google Scholar 

  19. Bucher P, Mermillod P, Morel P, Soravia C. Does mechanical bowel preparation have a role in preventing postoperative complications in elective colorectal surgery? Swiss Med Wkly 2004;134:69–74.

    PubMed  Google Scholar 

  20. Harmon JW, Tang DG, Gordon TA, Bowman HM, Choti MA, Kaufman HS, Bender JS, Duncan MD, Magnuson TH, Lillemoe KD, Cameron JL. Hospital volume can serve as a surrogate for surgeon volume for achieving excellent outcomes in colorectal resection. Ann Surg 1999;230:404–411.

    Article  PubMed  CAS  Google Scholar 

  21. Lustosa SA, Matos D, Atallah AN, Castro AA. Stapled versus handsewn methods for colorectal anastomosis surgery: a systematic review of randomized controlled trials. Sao Paulo Med J 2002;120:132–136.

    Article  PubMed  Google Scholar 

  22. Mahajna A, Krausz M, Rosin D, Shabtai M, Hershko D, Ayalon A, Zmora O. Bowel preparation is associated with spillage of bowel contents in colorectal surgery. Dis Colon Rectum 2005;48:1626–1631.

    Article  PubMed  Google Scholar 

  23. Bucher P, Gervaz P, Egger JF, Soravia C, Morel P. Morphologic alterations associated with mechanical bowel preparation before elective colorectal surgery: a randomized trial. Dis Colon Rectum 2006;49:109–112.

    Article  PubMed  Google Scholar 

  24. Valantas MR, Beck DE, Di Palma JA. Mechanical bowel preparation in the older surgical patient. Curr Surg 2004;61:320–324.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Servicio de Cirugía I, Division of Colorectal Surgery, Hospital Clínico San Carlos, Universidad Complutense de Madrid Medical School, Madrid, 28040, Spain

    Maria Jesús Pena-Soria, Julio M. Mayol, Rocio Anula-Fernandez, Ana Arbeo-Escolar & Jesús A. Fernandez-Represa

Authors
  1. Maria Jesús Pena-Soria
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Julio M. Mayol
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rocio Anula-Fernandez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ana Arbeo-Escolar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jesús A. Fernandez-Represa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Julio M. Mayol.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pena-Soria, M.J., Mayol, J.M., Anula-Fernandez, R. et al. Mechanical Bowel Preparation for Elective Colorectal Surgery with Primary Intraperitoneal Anastomosis by a Single Surgeon: Interim Analysis of a Prospective Single-Blinded Randomized Trial. J Gastrointest Surg 11, 562–567 (2007). https://doi.org/10.1007/s11605-007-0139-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-007-0139-6

Keywords

Search

Navigation