Colon and rectal surgery for cancer without mechanical bowel preparation: One-center randomized prospective trial
- PDF / 433,869 Bytes
- 5 Pages / 595 x 794 pts Page_size
- 97 Downloads / 211 Views
WORLD JOURNAL OF SURGICAL ONCOLOGY Open Access
RESEARCH
Colon and rectal surgery for cancer without mechanical bowel preparation: One-center randomized prospective trial Research
Stefano Scabini*, Edoardo Rimini, Emanuele Romairone, Renato Scordamaglia, Giampiero Damiani, Davide Pertile and Valter Ferrando
Abstract Background: Mechanical bowel preparation is routinely done before colon and rectal surgery, aimed at reducing the risk of postoperative infectious complications. The aim of the study was to assess whether elective colon and rectal surgery can be safely performed without preoperative mechanical bowel preparation. Methods: Patients undergoing elective colon and rectal resections with primary anastomosis were prospectively randomized into two groups. Group A had mechanical bowel preparation with polyethylene glycol before surgery, and group B had their surgery without preoperative mechanical bowel preparation. Patients were followed up for 30 days for wound, anastomotic, and intra-abdominal infectious complications. Results: Two hundred forty four patients were included in the study, 120 in group A and 124 in group B. Demographic characteristics, type of surgical procedure and type of anastomosis did not significantly differ between the two groups. There was no difference in the rate of surgical infectious complications between the two groups but the overall infectious complications rate was 20.0% in group A and 11.3% in group B (p .05). Wound infection (p = 0.18), anastomotic leak (p = 0.52), and intra-abdominal abscess (p = 0.36) occurred in 9.2%, 5.8%, and 5.0% versus 4.8%, 4.0%, and 2.4%, respectively. No mechanical bowel preparation seems to be safe also in rectal surgery. Conclusions: These results suggest that elective colon and rectal surgery may be safely performed without mechanical preparation. Background In the first half of the 20th century, mortality from colon and rectal surgery often exceeded 20%, [1] mainly attributed to sepsis. Modern surgical techniques and improved perioperative care have significantly lowered the mortality rate. Infectious complications, however, still are a major cause of morbidity in colorectal surgery, leading to increased cost, prolonged hospital stay, and occasional mortality [2]. Mechanical bowel preparation is aimed at cleaning the large bowel of fecal content, there by reducing the rate of infectious complications following surgery. Traditionally, bowel cleansing was achieved using enemas in combination with oral laxatives [3]. More recently, oral cathartic * Correspondence: [email protected] 1
Unit of Surgical Oncology, Department of Emato-Oncology, San Martino Hospital, Genoa, Italy
agents to induce diarrhea and cleanse the bowel from solid feces were developed. These new bowel preparation agents, such as polyethylene glycol and sodium phosphate, provide superior cleansing compared to the more traditional methods [4-6] and are used by most surgeons in preparation for colorectal surgery [7-9]. The practice of bowel cleansing before colorectal surge
Data Loading...
