scholarly journals P557 Increased risk of anastomotic leak in Crohn’s disease patients unable to complete preoperative mechanical bowel preparation

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S472-S472
Author(s):  
I Iesalnieks ◽  
F Marek ◽  
Z Kala ◽  
L Kunovsky
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Anastomotic Leak ◽  
Bowel Preparation ◽  
Mechanical Bowel Preparation ◽  
Oral Antibiotics ◽  
Septic Complications ◽  
Increased Risk ◽  
Postoperative Anastomotic Leak ◽  
Colorectal Resections

Abstract Background To assess the risk of postoperative anastomotic leak in Crohn’s disease patients unable to complete the preoperative mechanical bowel preparation (MBP): a prospective observational study from two referral centres in Germany and the Czech Republic. Methods Preoperative MBP was used routinely in all Crohn’s disease patients undergoing elective ileocolic or colorectal resections completed by the formation of an anastomosis since 6/2016. The MBP consisted of 2 L Polyethyleneglycol (PEG) solution combined with two doses of oral antibiotics Metronidazole and Paromomycin. The MBP was defined as incomplete when patients were not able to drink the whole amount of PEG solution due to side effects or complications. The primary endpoint was occurrence of anastomotic leak. The secondary endpoint was the incidence of postoperative intraabdominal septic complications (IASC) which were defined as an anastomotic leak, intraabdominal abscess or fistula and peritonitis. Results Between 6/2016 and 11/2019, 96 Crohn’s disease patients underwent elective ileocolic or colorectal resections after receiving preoperative MBP and oral antibiotics. Twenty-four (25%) developed complications of MBP, mostly vomiting; 17 patients (18%) were not able to complete MBP. The presence of extraintestinal disease manifestations (Hazard Ratio 4.8, p = 0.029), preoperative weight loss (HR 5.7, p = 0.019) and female sex (HR 13.3, p = 0.005) were associated with an increased probability not to be able to complete MBP. Postoperative anastomotic leak occurred in 2 patients (2%). The risk of anastomotic leak was significantly higher in patients unable to complete MBP (12%) as compared with patients with complete MBP (0%, p = 0.03). Postoperative IASC occurred in 7 patients (7%). Patient unable to complete preoperative MBP were at higher risk to develop IASC; however, the difference was not statistically significant (18% vs. 5%, p = 0.10) Conclusion The anastomotic leak rate is very low when preoperative mechanical bowel preparation and oral antibiotics have been used. However, patients not able to complete MBP might be at an increased risk.

scholarly journals P221 Crohn’s disease patients unable to complete preoperative mechanical bowel preparation have increased risk of anastomotic complications: results of a prospective observational study

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S275-S275
Author(s):  
L Kunovsky ◽  
F Marek ◽  
Z Kala ◽  
D Ivanecka ◽  
I Iesalnieks
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Observational Study ◽  
Anastomotic Leak ◽  
Prospective Observational Study ◽  
Mechanical Bowel Preparation ◽  
Oral Antibiotics ◽  
Increased Risk ◽  
Postoperative Anastomotic Leak ◽  
Colorectal Resections

Abstract Background To assess the risk of postoperative anastomotic leak in Crohn’s disease patients unable to complete the preoperative mechanical bowel preparation (MBP): a prospective observational study from two referral centers in Germany and the Czech Republic. Methods Preoperative MBP was used routinely in all Crohn’s disease patients undergoing elective ileocolic or colorectal resections completed by formation of an anastomosis since 6/2016. The MBP consisted of 2 L Polyethyleneglycol (PEG) solution combined with two doses of oral antibiotics Metronidazole/Paramomycin or Metronidazole/Neomycine. The MBP was defined as incomplete when patients were not able to drink the whole amount of PEG solution due to side effects or complications. The primary endpoint was the occurrence of anastomotic leak. The secondary endpoint was the incidence of postoperative intra-abdominal septic complications (IASC) which were defined as anastomotic leak, intra-abdominal abscess, fistula or peritonitis. Results Between 6/2016 and 3/2021, 157 Crohn’s disease patients underwent elective ileocolic or colorectal resections after receiving preoperative MBP and oral antibiotics. Forty (26%) developed complications from the MBP, mostly vomiting; twenty-nine patients (18.5%) were not able to complete the MBP. Female sex (HR 4.2, p=0.016) was associated with an increased probability of not being able to complete the MBP. Postoperative anastomotic leak occurred in 5 patients (3%). In a multivariate analysis, the risk of anastomotic leak was significantly higher in patients unable to complete the MBP (10.5%), as compared to patients with complete MBP (1.6%, p=0.01, HR 21.0). Postoperative IASC occurred in 7 patients (7%). Patients unable to complete preoperative MBP were at higher risk of developing IASC. However, the difference was not statistically significant (14% vs. 5%, p=0.12). Conclusion The anastomotic leak rate was low when preoperative MBP and oral antibiotics were used. However, patients not able to complete MBP might be at an increased risk.

scholarly journals Mechanical Bowel Preparation (MBP) Prior to Elective Colorectal Resections in Crohn’s Disease Patients

2018 ◽  
Vol 24 (4) ◽  
pp. 908-915 ◽  
Author(s):  
Igors Iesalnieks ◽  
Melanie Hoene ◽  
Theresa Bittermann ◽  
Hans J Schlitt ◽  
Christina Hackl
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Bowel Preparation ◽  
Mechanical Bowel Preparation ◽  
Colorectal Resections

scholarly journals Current Evidence of Combination of Oral Antibiotics and Mechanical Bowel Preparation in Elective Colorectal Surgery and Their Impact on Anastomotic Leak

2019 ◽  
Vol 27 (1) ◽  
pp. 101-102 ◽  
Author(s):  
Argyrios Ioannidis ◽  
Athanasios Zoikas ◽  
Steven D. Wexner
Keyword(s):  
Colorectal Surgery ◽  
Anastomotic Leak ◽  
Significant Role ◽  
Bowel Preparation ◽  
Mechanical Bowel Preparation ◽  
Current Evidence ◽  
Oral Antibiotics ◽  
Optimal Method ◽  
Elective Colorectal Surgery ◽  
Colorectal Resections

Anastomotic leak represents a potentially catastrophic complication following colorectal surgery. Preoperatively, bowel preparation has a significant role in anastomotic leak prevention, but the optimal method remains unclear. Recently, numerous studies have supported combined mechanical bowel preparation and oral antibiotics prior to elective colorectal operations. Based on the plethora of recent data, we hope that surgeons will routinely use a combination of oral antibiotics and mechanical bowel preparation prior to elective colorectal resections.

scholarly journals EP.TH.965Use of Oral Antibiotics as Adjunct to Systemic Antibiotics and Mechanical Bowel Preparation for Left Sided Colorectal Surgery. It is the time to trust the best available evidence and change the practice

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Shahin Hajibandeh ◽  
Shahab Hajibandeh ◽  
Christopher Thompson ◽  
Vijay Thumbe ◽  
Andrew Torrance ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Anastomotic Leak ◽  
Bowel Preparation ◽  
Mechanical Bowel Preparation ◽  
Surgical Site Infections ◽  
Oral Antibiotics ◽  
Intravenous Antibiotics ◽  
Clinically Significant ◽  
The Uk ◽  
Systemic Antibiotics

Abstract Aims To prospectively evaluate the clinical efficacy of oral antibiotics as an adjunct to intravenous antibiotics and mechanical bowel preparation (MBP) in patients undergoing left sided colorectal surgery. Methods All participants aged 18 years or older and of any gender undergoing an elective open or laparoscopic left sided colorectal resection for benign or malignant colorectal pathologies were considered. The intervention of interest was oral neomycin 1g every 4 hours combined with oral metronidazole 400mg every 8 hours from 24 hours before the proposed surgery. Surgical site infections (SSIs), anastomotic leak, paralytic ileus, need for intervention, and mortality were the evaluated outcome parameters. Results Forty-two consecutive patients received oral antibiotics as an adjunct to intravenous antibiotics and MBP before left sided colorectal surgery. The mean age was 58.8 ± 11.5. There were 23 males (54.8%) and 19 females (45.2%). Use of oral antibiotics was associated with SSI infection rate of 2.4% (1 patient). The rates of clinically significant and non-significant anastomotic leak were 0% and 2.9%, respectively. Moreover, postoperative ileus happened in 11.9% of patients. Furthermore, there was no mortality or need for re-intervention. Conclusions Use of oral antibiotics as an adjunct to intravenous antibiotics and MBP in patients undergoing left-sided colorectal surgery was associated with a surprisingly low rate of SSIs and no significant anastomotic leak. It is time to trust the best available evidence and incorporate the use of oral antibiotics as an adjunct to intravenous antibiotics and MBP in colorectal surgery protocols in the UK hospitals.

Special Considerations of Anastomotic Leaks in Crohn's Disease

2021 ◽  
Author(s):  
N. Nimalan A. Jeganathan ◽  
Walter A. Koltun
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Clinical Characteristics ◽  
Biologic Therapy ◽  
Published Data ◽  
Significant Heterogeneity ◽  
Steroid Use ◽  
Septic Complications ◽  
Increased Risk ◽  
Inflammatory Bowel

AbstractRates of anastomotic leak following intestinal resections in the setting of inflammatory bowel disease are significantly influenced by clinical characteristics. While the literature can be contradictory due to significant heterogeneity in the published data, several common themes appear to consistently arise. With respect to Crohn's disease, low serum albumin, preoperative abscess, reoperative abdominal surgery, and steroid use are associated with an increased risk of postoperative intra-abdominal septic complications. On the contrary, biologic therapy, immunomodulator use, and method of anastomosis appear not to confer increased anastomotic-related complications. Undoubtedly, a low rate of anastomotic leakage is inherent to procedures within colorectal surgery but diligent attention must be paid to identify, optimize, and, therefore, reduce known risks.

P015 ILEOCOLIC RESECTION FOR CROHN’S DISEASE: CURRENT TRENDS FROM ANALYSIS OF 2 YEARS OF NSQIP IBD COLLABORATIVE DATA

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S51-S52
Author(s):  
William Luo ◽  
Stefan Holubar ◽  
Liliana Bordeianou ◽  
Lynne Crawford ◽  
Bruce Hall ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Anastomotic Leak ◽  
Severe Disease ◽  
Multivariable Analysis ◽  
Ileocolic Resection ◽  
Improvement Program ◽  
Stoma Formation ◽  
Increased Risk ◽  
Secondary Outcomes

Abstract Background Ileocolic resection (ICR) is performed for Crohn’s disease (CD) patients with terminal ileitis requiring surgery. Current National Surgical Quality Improvement Program (NSQIP) data is lacking specificity around IBD surgery, including stoma formation and biologic therapies. The NSQIP IBD Collaborative (NSQIP-IBD) is a multicenter working group formed to better collect and analyze perioperative data unique to IBD patients under the auspices of NSQIP. We present retrospective analysis of a multicenter cohort of ICR for CD to describe the current practice of ICR for CD across our collaborative and explore factors associated with rates of postoperative complications on behalf of NSQIP-IBD. Methods Review of NSQIP data from 10 participating sites was performed to select ICR cases for CD from March 2017 to March 2019. In addition to standard data from NSQIP, IBD-specific data regarding stoma formation, immunosuppressant use (biologics, steroids, and immune modulators), and dysplasia is included. Primary outcome was anastomotic leak measured in a 30-day postoperative window in undiverted patients. Secondary outcomes were total non-leak complications and total postoperative infections. Multivariable analysis was performed to adjust for confounding pre- and intraoperative confounders. Backward selection of covariates and factors was performed using a cutoff of p<0.2 for main effects. Results 506 ICR cases for CD were identified. 78 patients had stomas per our unique ileostomy NSQIP-IBD variable, compared to 38 found by querying generally available NSQIP data (48.7% of total stomas). ICR patients receiving stoma were more likely to have more severe ASA class and weight loss and had significantly lower albumin and hematocrit. Age, BMI, and sex were similar in either group. Intraoperatively, stoma patients were more likely have worse wound class, be emergent, and longer operative time. 421 cases had complete baseline and intraoperative data for multivariable analysis of leak rates. 422 were available for secondary outcomes analysis. Multivariable analysis of leak rates showed significant association with infections prior to operation (PATOS; OR=6.6, 95% CI 1.1–40, p=0.041). Significant predictors of total postoperative complication rate and infection rate are shown in Tables 1 and 2, respectively. Conclusions NSQIP-IBD data provides clearer, more detailed data than the NSQIP colectomy module alone in IBD patients. We show that CD ICR patients receiving stomas were more emergent, had intraoperative infection, or had more severe disease. This is consistent with most contemporary surgical practices. Total infections PATOS are associated with increased risk of postoperative anastomotic leak, non-leak complications, and infections. NSQIP-IBD data improves on existing NSQIP data to allow a more robust analysis of factors and outcomes unique to IBD cases. We anticipate with more time and greater numbers we will be able to obtain even more granular data.

scholarly journals Interventions to reduce the incidence of surgical site infection in colorectal resections: systematic review with multicomponent network meta-analysis (INTRISSI): study protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e057226
Author(s):  
Juliane Friedrichs ◽  
Svenja Seide ◽  
Johannes Vey ◽  
Samuel Zimmermann ◽  
Julia Hardt ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Bowel Preparation ◽  
Meta Analysis ◽  
Mechanical Bowel Preparation ◽  
Supervised Machine Learning ◽  
Controlled Trials ◽  
Site Infection ◽  
Oral Antibiotics ◽  
Colorectal Resections

ObjectiveTo assess the relative contribution of intravenous antibiotic prophylaxis, mechanical bowel preparation, oral antibiotic prophylaxis, and combinations thereof towards the reduction of surgical site infection (SSI) incidence in elective colorectal resections.Methods and analysisA systematic search of randomised controlled trials comparing interventions to reduce SSI incidence will be conducted with predefined search terms in the following databases: MEDLINE, LILACS, Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Database of Systematic Reviews (CDSR). Additionally, several online databases will be searched for ongoing trials, and conference proceedings and reference lists of retrieved articles will be hand searched. The title–abstract screening will be partly performed by means of a semiautomated supervised machine learning approach, which will be trained on a subset of the identified titles and abstracts identified through traditional screening methods.The primary analysis will be a multicomponent network meta-analysis, as we expect to identify studies that investigate combinations of interventions (eg, mechanical bowel preparation combined with oral antibiotics) as well as studies that focus on individual components (mechanical bowel preparation or oral antibiotics). By means of a multicomponent network meta-analysis, we aim at estimating the effects of the separate components along the effects of the observed combinations. To account for between-trial heterogeneity, a random-effect approach will be combined with inverse variance weighting for estimation of the treatment effects. Associated 95% CIs will be calculated as well as the ranking for each component in the network using P scores. Results will be visualised by network graphics and forest plots of the overall pairwise effect estimates. Comparison-adjusted funnel plots will be used to assess publication bias.Ethics and disseminationEthical approval by the Ethical Committee of the Medical Faculty of the Martin-Luther-University Halle-Wittenberg (ID of approval: 2021–148). Results shall be disseminated directly to decision-makers (eg, surgeons, gastroenterologists, wound care specialists) by means of publication in peer-reviewed journals, presentation at conferences and through the media (eg, radio, TV, etc).PROSPERO registration numberCRD42021267322.

scholarly journals Low dietary fiber promotes enteric expansion of a Crohn's disease-associated pathobiont independent of obesity

2021 ◽  
Author(s):  
Trevor C. Lau ◽  
Aline A. Fiebig-Comyn ◽  
Christopher R. Shaler ◽  
Joseph B. McPhee ◽  
Brian K. Coombes ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Dietary Fiber ◽  
Enteric Infection ◽  
Oral Antibiotics ◽  
High Fat ◽  
E Coli ◽  
Increased Risk ◽  
Main Driver ◽  
Dietary Component

Obesity is associated with metabolic, immunological, and infectious disease comorbidities, including an increased risk of enteric infection and inflammatory bowel disease such as Crohn's disease (CD). Expansion of intestinal pathobionts such as adherent-invasive Escherichia coli (AIEC) is a common dysbiotic feature of CD, which is amplified by prior use of oral antibiotics. Although high-fat, high-sugar diets are associated with dysbiotic expansion of E. coli, it is unknown if the content of fat or another dietary component in obesogenic diets is sufficient to promote AIEC expansion. Here, we found that administration of an antibiotic combined with feeding mice an obesogenic low fiber, high sucrose, high fat diet (HFD) that is typically used in rodent obesity studies promoted AIEC intestinal expansion. Even a short-term (i.e., 1-day) pulse of HFD feeding before infection was sufficient to promote AIEC expansion, indicating that the magnitude of obesity was not the main driver of AIEC expansion. Controlled diet experiments demonstrated that neither dietary fat nor sugar were the key determinants of AIEC colonization, but that lowering dietary fiber from approximately 13% to 5-6% was sufficient to promote intestinal expansion of AIEC when combined with antibiotics in mice. When combined with antibiotics, lowering fiber promoted AIEC intestinal expansion to a similar extent as widely used HFDs in mice. However, lowering dietary fiber was sufficient to promote AIEC intestinal expansion without affecting body mass. Our results show that low dietary fiber combined with oral antibiotics are environmental factors that promote expansion of Crohn's disease-associated pathobionts in the gut.

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