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.

scholarly journals The gut microbiota and colorectal surgery outcomes: facts or hype? A narrative review

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Annamaria Agnes ◽  
Caterina Puccioni ◽  
Domenico D’Ugo ◽  
Antonio Gasbarrini ◽  
Alberto Biondi ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Gut Microbiota ◽  
Bowel Preparation ◽  
Mechanical Bowel Preparation ◽  
Current Evidence ◽  
Oral Antibiotics ◽  
Surgery Complications ◽  
Surgery Outcomes ◽  
Eras Protocol

Abstract Background The gut microbiota (GM) has been proposed as one of the main determinants of colorectal surgery complications and theorized as the “missing factor” that could explain still poorly understood complications. Herein, we investigate this theory and report the current evidence on the role of the GM in colorectal surgery. Methods We first present the findings associating the role of the GM with the physiological response to surgery. Second, the change in GM composition during and after surgery and its association with colorectal surgery complications (ileus, adhesions, surgical-site infections, anastomotic leak, and diversion colitis) are reviewed. Finally, we present the findings linking GM science to the application of the enhanced recovery after surgery (ERAS) protocol, for the use of oral antibiotics with mechanical bowel preparation and for the administration of probiotics/synbiotics. Results According to preclinical and translational evidence, the GM is capable of influencing colorectal surgery outcomes. Clinical evidence supports the application of an ERAS protocol and the preoperative administration of multistrain probiotics/synbiotics. GM manipulation with oral antibiotics with mechanical bowel preparation still has uncertain benefits in right-sided colic resection but is very promising for left-sided colic resection. Conclusions The GM may be a determinant of colorectal surgery outcomes. There is an emerging need to implement translational research on the topic. Future clinical studies should clarify the composition of preoperative and postoperative GM and the impact of the GM on different colorectal surgery complications and should assess the validity of GM-targeted measures in effectively reducing complications for all colorectal surgery locations.

scholarly journals MODERN VIEW ON DIFFERENT KINDS OF BOWEL PREPARATION FOR ELECTIVE COLORECTAL SURGERY

2019 ◽  
Vol 18 (3) ◽  
pp. 97-102
Author(s):  
A. Yu. Olkina ◽  
A. S. Petrov ◽  
L. L. Panaiotti ◽  
A. М. Karachun ◽  
T. S. Lankov
Keyword(s):  
Colorectal Surgery ◽  
Bowel Preparation ◽  
Standard Procedure ◽  
Mechanical Bowel Preparation ◽  
Term Treatment ◽  
Current Data ◽  
Oral Antibiotics ◽  
Short Term Treatment ◽  
Elective Colorectal Surgery ◽  
Preoperative Bowel Preparation

Purpose: to assess current data on the effect of different approaches to preoperative bowel preparation before elective colorectal surgery on short-term treatment outcomes.Material and Methods. Online system PubMed of U.S. National Library of Medicine was used to find articles with key words “mechanical bowel preparation”, “surgical site infection”, “oral antibiotics”. A total of 226 articles were reviewed. 31 articles were selected for final review. Furthermore, ClinicalTrials.gov site was used to find actual and recruiting trials.Results. Mechanical bowel preparation (MBP) used to be a standard procedure for a long time. Nowadays, routine use of MBP seems to be debatable. Alternative approaches, e.g. absolutely no preparation or the use of MBP in combination with oral antibiotics, are considered. Data on performing different kinds of bowel preparation is reviewed in this article.Conclusion. Optimal approach of preoperative bowel preparation is still questionable. Combination of mechanical bowel preparation and oral antibiotics seems to be a preferable method. However, there is not enough evidence to exclude anothertechniques. It’s required to conduct additional randomized controlled trials.

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.

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