Published online Apr 27, 2019. doi: 10.4240/wjgs.v11.i4.218
Peer-review started: March 4, 2019
First decision: March 19, 2019
Revised: March 23, 2019
Accepted: April 9, 2019
Article in press: April 9, 2019
Published online: April 27, 2019
Processing time: 55 Days and 10.8 Hours
Controversy exists regarding the impact of preoperative bowel preparation on patients undergoing colorectal surgery. This is due to previous research studies, which fail to demonstrate protective effects of mechanical bowel preparation against postoperative complications. However, in recent studies, combination therapy with oral antibiotics (OAB) and mechanical bowel preparation seems to be beneficial for patients undergoing an elective colorectal operation.
To determine the association between preoperative bowel preparation and postoperative anastomotic leak management (surgical vs non-surgical).
Patients with anastomotic leak after colorectal surgery were identified from the 2013 and 2014 Colectomy Targeted American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database and were employed for analysis. Every patient was assigned to one of three following groups based on the type of preoperative bowel preparation: first group-mechanical bowel preparation in combination with OAB, second group-mechanical bowel preparation alone, and third group-no preparation.
A total of 652 patients had anastomotic leak after a colectomy from January 1, 2013 through December 31, 2014. Baseline characteristics were assessed and found that there were no statistically significant differences between the three groups in terms of age, gender, American Society of Anesthesiologists score, and other preoperative characteristics. A χ2 test of homogeneity was conducted and there was no statistically/clinically significant difference between the three categories of bowel preparation in terms of reoperation.
The implementation of mechanical bowel preparation and antibiotic use in patients who are going to undergo a colon resection does not influence the treatment of any possible anastomotic leakage.
Core tip: Anastomotic leak after colon resection contributes significantly to postoperative morbidity and mortality. Surgeons are constantly seeking ways to decrease the rate of the anastomotic leak by optimizing the patient before the operation. Currently the preoperative bowel preparation constitutes a significant field of debate. We aimed to determine the association between preoperative bowel preparation and postoperative anastomotic leak management, surgical versus non-surgical. We found that the implementation of mechanical bowel preparation and antibiotic use in patients who are going to undergo a colon resection does not influence the treatment of any possible anastomotic leakage.