Pre-Operative Mechanical Bowel Preparation Does Not Affect the Impact of Anastomosis Leakage in Left-Side Colorectal Surgery—A Single Center Observational Study
Abstract
:1. Introduction
2. Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Type of foods | Lean meat (veal, beef, pork, chicken), fish filet Soups, butter, oil, milk, dairy products Mashed potatoes, thick sauces Rise, soft-boiled egg Fine biscuits, crispbread, stale bakery products, fruit compotes Early harvest vegetables (carrots, cauliflower, kohlrabi, celery, parsley, spinach) All beverages |
Way of preparation | All kinds of meat should be ground and liquidized immediately once they are cooked. The mashed potatoes and thick sauces should be liquidized. Vegetables should be soft-cooked. |
Low risk | Loss of weight >5% in last 2 months or oral intake <50–75% compared to the previous period |
Moderate risk | Loss of weight >5% in last 2 months or BMI 18.5–20.5 as well as worsening of patient´s overall condition and oral intake <25–50% compared to the previous period |
High risk | Loss of weight >5% in last 2 months (approx. 15% in 3 months), BMI < 18.5 as well as worsening of patient´s overall condition and oral intake <0–25% compared to the previous period |
Surgical Procedure | (n = 87) | (n = 98) |
---|---|---|
Conservative surgery | 30 (34.48%) | 22 (22.45%) |
Laparoscopic surgery | 53 (60.92%) | 73 (74.49%) |
Conversion from laparoscopy | 12 (22.64%) | 4 (5.48%) |
Other | 4 (4.6%) | 3 (3.06%) |
Hand-sewn anastomosis | 8 (9.19%) | 10 (10.2%) |
Stapled anastomosis | 75 (86.21%) | 85 (86.74%) |
Complications | (n = 87) | (n = 98) |
---|---|---|
Wound complications | 2 (2.30%) | 1 (1.02%) |
-seroma | 2 (2.30%) | 0 |
-SSI | 0 | 1 (1.02%) |
Bleeding | 4 (4.60%) | 0 |
Anastomotic leakage | 5 (5.74%) | 1 (1.02%) |
Colon | 2 | 0 |
Rectum | 3 | 1 |
Ileus condition | 0 | 0 |
Intra-abdominal infection | 0 | 0 |
Total rate of conversions | 11 (12.64%) | 1 (1.02%) |
Re-surgery | 1 (1.15%) | 1 (1.02%) |
OR (95% CI a) | ||
---|---|---|
Treatment | IV + OA | MBP + IV + OA |
OA alone | 0.15 (0.06–0.33) b | 0.19(0.08–0.43) b |
MBP + OA | 0.10 (0.04–0.25) b | 0.14 (0.07–0.31) b |
MBP + IVB + OA | 0.18 (0.08–0.41) b | 0.25 (0.12–0.51) b |
MBP + IV | 0.22 (0.12–0.40) b | 0.31 (0.20–0.48) b |
IV alone | 0.27 (0.15–0.50) b | 0.38 (0.24–0.62) b |
IV + E | 0.26 (0.11–0.63) c | 0.37 (0.17–0.81) d |
MBP + IV + OA | 0.71 (0.41–1.21) | NA |
IV + OA ± E | NA | 1.41 (0.83–2.42) |
First Author | Study Design | Year | No. of Patients | Population | MBP | Non-MBP | p-Value | MBP | Non-MBP | p-Value |
---|---|---|---|---|---|---|---|---|---|---|
Zmora [36] | Randomized prospective trial | 2003 | 380 | Elective colon and rectal surgery with primary anastomosis | 12/187 (6.4) | 11/193 (5.7) | NS | 7/187 (3.7) | 4/193 (2.1) | NS |
Bucher [37] | Randomized clinical trial | 2005 | 153 | Elective left-sided colorectal surgery with primary anastomosis | 10/78 (12.8) | 3/75 (4.0) | 0.070 | 5/78 (6.4) | 1/75 (1.3) | 0.210 |
Santos [5] | Prospective randomized trial | 1994 | 149 | Elective colorectal surgery | 17/72 (23.6) | 9/77 (11.7) | <0.050 | 7/72 (9.7) | 4/77 (5.2) | 0.520 |
Jung [31] | Multicenter randomized clinical trial | 2007 | 1343 | Elective open colon surgery | 54/686 (7.9) | 42/657 (6.8) | NS | 13/686 (2.3) | 17/657 (2.6) | NS |
Fa-SI-Oen [38] | Multicenter randomized clinical trial | 2005 | 250 | Elective colon surgery | 9/125 (7.2) | 7/125 (5.6) | 0.610 | 7/125 (5.6) | 6/125 (4.8) | 0.780 |
Pineda [39] | Meta-analysis and review | 2008 | 4601 (13 trials) | Elective colorectal surgical resection | 227/2304 (9.9) | 201/2297 (8.8) | 0.155 | 97/2304 (4.2) | 81/2297 (3.5) | 0.206 |
Slim [40] | Meta-analysis and review | 2004 | 1454 (7 trials) | Elective colorectal surgery | 53/720 (7.4) | 42/734 (5.7) | 0.175 | 39/701 (5.6) | 23/708 (3.2) | 0.032 |
Guenaga [25] | Meta-analysis and review | 2011 | 5805 (18 trials) | Elective colorectal surgery | 223/2305 (9.7) | 196/2290 (8.6) | NS | 101/2275 (4.4) | 103/2258 (4.5) | NS |
Study | # of Patients | MBP Agent | Anastomotic Leaks with MBP (%) | Anastomotic Leaks without MBP (%) | p Value | Wound Infections with MBP (%) | Wound Infections without MBP (%) | p Value |
---|---|---|---|---|---|---|---|---|
Brownson et al., 1992 [26] | 179 | PEG | 11.9 | 1.5 | 0.03 | 5.8 | 7.5 | 0.77 |
Santos et al., 1994 [5] | 149 | Mineral oil, agar, and phenol-phthalein; mannitol | 10.4 | 5.3 | 0.34 | 23.6 | 11.7 | 0.08 |
Burke et al., 1994 [27] | 169 | Sodium picosulfate | 3.7 | 4.6 | 1 | 4.9 | 3.4 | 0.71 |
Fillman et al., 1995 [41] | 60 | Mannitol | 8.7 | 4.3 | 1 | 3.3 | 6.7 | 1 |
Tabusso et al., 2002 [42] | 47 | Mannitol or PEG | 20.8 | 0 | 0.04 | 8.3 | 0 | 0.49 |
Miettinen et al., 2003 [43] | 267 | PEG | 3.8 | 2.5 | 0.72 | 3.6 | 2.3 | 0.72 |
Bucher et al., 2006 [37] | 153 | PEG | 6.4 | 1.3 | 0.21 | 12.8 | 4 | 0.07 |
Ram et al., 2005 [44] | 329 | NaP | 0.6 | 1.3 | 1 | 9.8 | 6.1 | 0.22 |
Fa-Si-Oen et al., 2005 [38] | 250 | PEG | 5.6 | 4.8 | 0.78 | 7.2 | 5.6 | 0.79 |
Zmora et al., 2006 [45] | 249 | PEG | 4.2 | 2.3 | 0.48 | 6.7 | 10.1 | 0.36 |
Pena-Soria et al., 2007 [46] | 97 | PEG | 8.3 | 4.1 | 0.05 | 12.5 | 12.2 | 1 |
Jung et al., 2007 [31] | 1343 | PEG NaP Enema | 1.9 | 2.6 | 0.46 | 7.9 | 6.4 | 0.34 |
Contant et al., 2007 [47] | 1354 | PEG + bisacodyl or NaP | 4.8 | 5.4 | 0.69 | 13.4 | 14.0 | 0.75 |
Guideline | Year of Publication | Mechanical Bowel Preparation (MBP) | Oral Antibiotic Prophylaxis (OAP) | Perioperative Intravenous (IV) Antibiotics |
---|---|---|---|---|
World Health Organisation (WHO) | 2018 | (x) | (x) | (x) |
National Institute of Clinical Excellence (NICE) | 2019 | (x) | ||
American Society of Colon and Rectal Surgeons (ASCRS) | 2019 | (x) | (x) | (x) |
Association of Coloproctology of Great Britain & Ireland (ACPGBI) | 2017 | (x) | ||
Australian Cancer Council | 2018 | (x) | ||
Japan Society for Surgical Infection | 2021 | (x) | (x) | (x) |
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Danihel, L.; Cerny, M.; Dropco, I.; Zrnikova, P.; Schnorrer, M.; Smolar, M.; Misanik, M.; Durdik, S. Pre-Operative Mechanical Bowel Preparation Does Not Affect the Impact of Anastomosis Leakage in Left-Side Colorectal Surgery—A Single Center Observational Study. Life 2024, 14, 1092. https://doi.org/10.3390/life14091092
Danihel L, Cerny M, Dropco I, Zrnikova P, Schnorrer M, Smolar M, Misanik M, Durdik S. Pre-Operative Mechanical Bowel Preparation Does Not Affect the Impact of Anastomosis Leakage in Left-Side Colorectal Surgery—A Single Center Observational Study. Life. 2024; 14(9):1092. https://doi.org/10.3390/life14091092
Chicago/Turabian StyleDanihel, Ludovít, Marian Cerny, Ivor Dropco, Petra Zrnikova, Milan Schnorrer, Marek Smolar, Miloslav Misanik, and Stefan Durdik. 2024. "Pre-Operative Mechanical Bowel Preparation Does Not Affect the Impact of Anastomosis Leakage in Left-Side Colorectal Surgery—A Single Center Observational Study" Life 14, no. 9: 1092. https://doi.org/10.3390/life14091092