Preoperative mechanical bowel preparation combined with oral antibacterials in the prevention of complications of surgery for rectal and rectosigmoid junction cancer

Aim: To evaluate the efficacy of mechanical bowel preparation (MBP) combined with oral antibacterials for the prevention of postoperative complications when preparing a patient for anterior rectal resection.Materials and methods: We analyzed shortterm results in 77 patients who had undergone anterior rectal resection for rectal and rectosigmoid junction cancer. Forty five (45) patients were prepared for surgery only with MBP. In 32 patients, in addition to MBP, oral antibacterial agents ciprofloxacin and metronidazole were used preoperatively.Results: The overall rate of postoperative complications was 6.25% (2/32 patients) in the group of combined preparation for surgery and 15.5% (7/45) in the group using only MBP. Surgical wound infection occurred in 1 patient in the combined preparation group and in 4 patients in the MBP only group. There was no anastomotic leak in the combined preparation group, whereas in the MBP only group, anastomotic leak occurred in 2 patients.Conclusion: Combined use of oral antibacterials and MBP before anterior rectal resection makes it possible to achieve an extremely low rate of the colorectal anastomosis leak. Further studies into the efficacy of this preparation regimen are needed, along with their discussion in the professional communities.

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Influence of combined mechanical-chemical versus mechanical bowel preparation on anastomotic leak and surgical site infections after elective resection of left colon cancer

International Surgery Journal ◽

10.18203/2349-2902.isj20204112 ◽

2020 ◽

Vol 7 (10) ◽

pp. 3192

Author(s):

Mohamed Mahmoud Ali ◽

Ashraf Mohammad El-Badry

Keyword(s):

Colon Cancer ◽

Postoperative Complications ◽

Anastomotic Leak ◽

Bowel Preparation ◽

Mechanical Bowel Preparation ◽

Surgical Site Infections ◽

Left Colon ◽

Chemical Preparation ◽

Elective Resection ◽

Left Colon Cancer

Background: Mechanical bowel preparation (MBP) before elective resection of left colon cancer remains controversial. We propose that the protective effect of MBP is dependent on its combination with chemical preparation by oral antibiotics.Methods: Medical data of adult patients with left colon cancer who underwent elective resection at Sohag University Hospital (August 2016-March 2019) were reviewed. Anastomotic leak (AL), surgical site infections (SSI), postoperative morbidity and mortality were compared among patients who preoperatively received MBP followed by chemical preparation with oral antibiotics (MBP and OABx group) versus another group of preoperative MPB alone (MBP group).Results: Forty-two patients with left colon adenocarcinoma were enrolled, 21 per group. Overall, sigmoid colon was the most common site of left sided colon cancer (76%). Malignant lesions were found in proximal sigmoid in 19 (45%), rectosigmoid in 13 (31%), descending colon in 8 (19%) and splenic flexure in 2 (5%) patients. Dukes’ classification was A in 6 (14%), B in 19 (45%) and C in 17 (41%) patients. Compared with MBP, MBP and OABx group showed significantly lower rates of anastomotic leak (3 patients (14%) versus 1 (5%) respectively, p<0.05) and surgical site and intraabdominal infections (7 patients (33%) versus 2 (10%), p<0.05). MBP and OABx group exhibited lesser grades of postoperative complications (p<0.05) and shorter hospital stay (p<0.05). Postoperative mortality occurred only in the MBP group.Conclusions: Combined mechanical-chemical bowel preparation prior to elective resection of left colon cancer confers superior clinical outcome regarding anastomotic leak, surgical site infections and overall postoperative complications.

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Management of postoperative complications during laparoscopic anterior rectal resection

Minerva Surgery ◽

10.23736/s2724-5691.21.08890-0 ◽

2021 ◽

Author(s):

Armando G. Franchini Melani ◽

Luis G. Capochin Romagnolo

Keyword(s):

Postoperative Complications ◽

Rectal Resection ◽

Anterior Rectal Resection

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1035 Meta-Analysis of Mechanical Bowel Preparation for Elective Colon and Rectal Resection

Gastroenterology ◽

10.1016/s0016-5085(08)64029-9 ◽

2008 ◽

Vol 134 (4) ◽

pp. A-860

Author(s):

Carlos E. Pineda ◽

Andrew A. Shelton ◽

Tina Hernandez-Boussard ◽

John M. Morton ◽

Mark L. Welton

Keyword(s):

Bowel Preparation ◽

Rectal Resection ◽

Meta Analysis ◽

Mechanical Bowel Preparation ◽

Elective Colon

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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

British Journal of Surgery ◽

10.1093/bjs/znab309.100 ◽

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.

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Incidence of Anastomotic Leak in Patients Undergoing Elective Colon Resection without Mechanical Bowel Preparation: Our Updated Experience and Two-year Review

The American Surgeon ◽

10.1177/000313480907500915 ◽

2009 ◽

Vol 75 (9) ◽

pp. 828-833 ◽

Cited By ~ 8

Author(s):

Lisa J. Harris ◽

Neil Moudgill ◽

Eric Hager ◽

Hamid Abdollahi ◽

Scott Goldstein

Keyword(s):

Anastomotic Leak ◽

Bowel Preparation ◽

Ileoanal Anastomosis ◽

Mechanical Bowel Preparation ◽

Colon Resection ◽

Elective Colorectal Surgery ◽

Institutional Review ◽

Stage Renal Disease ◽

End Stage ◽

Elective Colon

Mechanical bowel preparation before elective colon resection has recently been questioned in the literature. We report a prospective study evaluating the anastomotic leak rate in patients undergoing elective colorectal surgery without preoperative mechanical bowel preparation. One hundred fifty-three patients undergoing elective colon resection from July 2006 to June 2008 were enrolled into this Institutional Review Board-approved study. All patients were operated on by a single surgeon at a single institution. No patients received mechanical bowel preparation. Of the 153 patients enrolled, 51.6 per cent had a colorectostomy, 32 per cent had an ileocolostomy, 10.4 per cent had a colocolostomy 5.2 per cent had an ileoanal anastomosis, and 0.6 per cent had an ileorectostomy performed. A total of eight patients (5.2%) developed an anastomotic leak. Of these patients, four required reoperation, three were managed with percutaneous drainage, and one was managed with antibiotics alone. Five of the eight patients who developed an anastomotic leak had significant preoperative comorbidities, including neoadjuvant radiation therapy, diabetes mellitus, end-stage renal disease, prior anastomotic leak, and tobacco use. Elective colon resection can be performed safely without preoperative mechanical bowel preparation. Vigilance for anastomotic leak must be maintained at all times, especially in patients with comorbidities that predispose to anastomotic leak.

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Anastomotic Leak Rate after Low Anterior Resection for Rectal Cancer after Chemoradiation Therapy

The American Surgeon ◽

10.1177/000313481007600833 ◽

2010 ◽

Vol 76 (8) ◽

pp. 869-871 ◽

Cited By ~ 8

Author(s):

Benjamin R. Phillips ◽

Lisa J. Harris ◽

Pinckney J. Maxwell ◽

Gerald A Isenberg ◽

Scott D. Goldstein

Keyword(s):

Anastomotic Leak ◽

Rectal Resection ◽

Colorectal Anastomosis ◽

Neoadjuvant Chemoradiation ◽

Contrast Enema ◽

Chemoradiation Therapy ◽

Leak Rate ◽

Stoma Reversal ◽

Anastomotic Leak Rate ◽

Preoperative Chemoradiation Therapy

Anastomotic leak may be the most concerning complication after colorectal anastomosis. To compare open with laparoscopic rectal resection, we must have accurate leak rates in patients who have received neoadjuvant chemoradiation therapy to serve as a benchmark for comparison. All patients who had preoperative chemoradiation therapy with rectal resection and low pelvic anastomosis for cancer in a single colorectal practice over a 7-year period were retrospectively reviewed. All patients had proximal diversion and a contrast enema study before stoma reversal. Eighty-seven consecutive patients were included in the study. Average age was 58 years. Fifty-nine per cent of patients were male. Sixty-six per cent were smokers. Pathologic T stage was 5 per cent TO, 16 per cent T1, 28 per cent T2, 47 per cent T3, and 5 per cent T4. Seventy-five per cent of patients were pathologically lymph node-negative. Average time to stoma reversal was 122 days. Total anastomotic leak rate was 10.3 per cent (8% clinical leaks). Five (56%) patients with leak successfully underwent reversal of their diverting stoma (average time to reversal, 290 days). Patients who had the complication of anastomotic leakage had less likelihood of stoma reversal and a significantly prolonged time to stoma reversal.

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The impact of preoperative preparation on postoperative complications in patients with colorectal cancer

Romanian Journal of Medical Practice ◽

10.37897/rjmp.2016.4.4 ◽

2016 ◽

Vol 11 (4) ◽

pp. 311-316

Author(s):

Octavia Cristina RUSU ◽

◽

Radu Virgil COSTEA ◽

Cristian Constantin POPA ◽

Ştefan Ilie NEAGU ◽

...

Keyword(s):

Colorectal Cancer ◽

Postoperative Complications ◽

Bowel Preparation ◽

Nutritional Support ◽

Mechanical Bowel Preparation ◽

Antimicrobial Treatment ◽

Cancer Death ◽

Preoperative Preparation ◽

Meta Analyses ◽

The Impact

Colorectal cancer is a frequently encountered disease. In most countries, it represents the second leading cause of cancer death. The treatment with radical intent of this condition is surgical. Objective: Through this study, we want to update some data regarding the impact of nutrition and the preoperative mechanical bowel preparation on postoperative complications, in patients who need surgical treatment for colorectal cancer. Material and Method: Relevant articles in the field, contained in international databases were analysed, with no language exclusion, including clinical trials and meta-analyses performed between 1994 and 2015. Conclusions: Preoperative preparation is particularly important in the postoperative evolution of the patients with colorectal cancer and it is based on several main principles: nutritional support, antimicrobial treatment and mechanical bowel preparation.

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Comparative Study of Postoperative Complications in Patients With and Without an Obstruction Who Had Left-Sided Colorectal Cancer and Underwent a Single-Stage Operation After Mechanical Bowel Preparation

Annals of Coloproctology ◽

10.3393/ac.2014.30.6.251 ◽

2014 ◽

Vol 30 (6) ◽

pp. 251 ◽

Cited By ~ 3

Author(s):

Sang Hun Jung ◽

Jae Hwang Kim

Keyword(s):

Colorectal Cancer ◽

Postoperative Complications ◽

Comparative Study ◽

Bowel Preparation ◽

Mechanical Bowel Preparation ◽

Single Stage

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Comparison of the Incidence of Wound Infection and Anastomotic Leak Depending on the Type of Mechanical Bowel Preparation (MBP) Prior to Surgery for Rectal Cancer

Nippon Daicho Komonbyo Gakkai Zasshi ◽

10.3862/jcoloproctology.60.385 ◽

2007 ◽

Vol 60 (7) ◽

pp. 385-391 ◽

Cited By ~ 1

Author(s):

H. Hazama ◽

S. Yamaguchi ◽

S. Akamoto ◽

H. Tomioka ◽

Y. Kinugasa ◽

...

Keyword(s):

Rectal Cancer ◽

Wound Infection ◽

Anastomotic Leak ◽

Bowel Preparation ◽

Mechanical Bowel Preparation

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

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.685 ◽

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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