Effect of mechanical bowel preparation with polyethyleneglycol on bacterial contamination and wound infection in patients undergoing elective open colon surgery

Infections at the surgical site continue to occur in as many as 20% of elective colon resection cases. Methods to reduce these infections are inconsistently applied. Surgical site infection (SSI) is the result of multiple interactive variables including the inoculum of bacteria that contaminate the site, the virulence of the contaminating microbes, and the local environment at the surgical site. These variables that promote infection are potentially offset by the effectiveness of the host defense. Reduction in the inoculum of bacteria is achieved by appropriate surgical site preparation, systemic preventive antibiotics, and use of mechanical bowel preparation in conjunction with the oral antibiotic bowel preparation. Intraoperative reduction of hematoma, necrotic tissue, foreign bodies, and tissue dead space will reduce infections. Enhancement of the host may be achieved by perioperative supplemental oxygenation, maintenance of normothermia, and glycemic control. These methods require additional research to identify optimum application. Uniform application of currently understood methods and continued research into new methods to reduce microbial contamination and enhancement of host responsiveness can lead to better outcomes.

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Is the Surgical Community Ready to Omit Mechanical Bowel Preparation Before Colon Surgery?

Annals of Surgery ◽

10.1097/sla.0b013e318211d8e8 ◽

2011 ◽

pp. 1

Author(s):

Karem Slim

Keyword(s):

Bowel Preparation ◽

Mechanical Bowel Preparation ◽

Colon Surgery

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Are preoperative oral antibiotics effective in reducing the incidence of anastomotic leakage after Colorectal cancer surgery: Study protocol for a prospective, multicentre, randomized controlled study

10.21203/rs.3.rs-600372/v1 ◽

2021 ◽

Author(s):

Rui Qi Gao ◽

WeiDong Wang ◽

PengFei Yu ◽

ZhenChang Mo ◽

DanSheng Dong ◽

...

Keyword(s):

Anastomotic Leakage ◽

Bowel Preparation ◽

Mechanical Bowel Preparation ◽

Surgical Site Infections ◽

Colon Surgery ◽

Ethics Committee ◽

Oral Antibiotics ◽

Colorectal Cancer Surgery ◽

Randomized Controlled ◽

Intestinal Preparation

Abstract Introduction The optimal preoperative preparation for elective colorectal cancer surgery has been debated in academic circles for decades. Previously, many expert teams have conducted studies on whether preoperative mechanical bowel preparation and preoperative oral antibiotics can effectively reduce the incidence of postoperative complications, such as surgical site infections and anastomotic leakage. Most of the results of these studies have suggested that preoperative mechanical bowel preparation for elective colon surgery has no significant effect on the occurrence of surgical site infections and anastomotic leakage. Methods/design This study will examine whether oral antibiotic bowel preparation (OABP) influences the incidence of anastomotic leakage after surgery in a prospective, multicentre, randomized controlled trial that will enrol 1500 patients who need colon surgery. The primary endpoint, incidence of anastomotic leakage, is based on 2.3% in the OABP ± mechanical bowel preparation (MBP) group in the study by Morris et al. The patients will be randomized (1:1) into two groups: the test group will be given antibiotics (both neomycin 1 g and metronidazole 1 g) the day before surgery, and the control group will not have any special intestinal preparation before surgery, including oral antibiotics or mechanical intestinal preparation. All study-related clinical data, such as general patient information, past medical history, laboratory examination, imaging results, and surgery details, will be recorded before surgery and during the time of hospitalization. The occurrence of postoperative fistulas, including anastomotic leakage, will be recorded as the main severe postoperative adverse event and will represent the primary endpoint. Ethics and dissemination Ethics and dissemination Ethics approval has been obtained from the Ethics Committee at the Chinese Ethics Committee of Registering Clinical Trials(ChiECRCT20200173). The results of this study will be disseminated at several research conferences and as published articles in peer-reviewed journals. Trial registration: ChiCTR2000035550. Registered on 13 Aug 2020.

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