SS  Vol.3 No.3 , March 2012
Outcome of Anastomotic Leakage after Colorectal Surgery in Patients with or without Preoperative Mechanical Bowel Irrigation: An Observational Study
Background: Randomized controlled trials have demonstrated that the rate of anastomotic leakage after laparoscopic colorectal surgery does not differ between patients with or without preoperative bowel preparation. There is, however, still an ongoing discussion that infectious complications consequential to anastomotic leakage, in particular sepsis, are more severe in patients without preoperative bowel cleaning. The aim of this study is to evaluate the assumption that postoperative sepsis in patients undergoing colorectal surgery without mechanical preoperative bowel irrigation is more severe compared to patients with bowel preparation. Methods: In the surgical unit in a teaching hospital in Zurich pa- tients undergoing laparoscopic colorectal surgery were consecutively included in the study. 367 patients with colorectal surgery between December 2000 and April 2004 underwent preoperative mechanical bowel irrigation. From May 2004 until April 2008 colorectal surgery was performed in 367 patients without bowel irrigation. Outcomes of interest are: Severity of sepsis in patients with postoperative anastomotic leakage, assessed by the necessity of referral to ICU, length of stay in the ICU and total length of hospital stay. Results: 734 patients were included in the study, 367 patients with and 367 without preoperative bowel preparation. In 43 patients an anastomotic insufficiency was diagnosed, 26 in the group with and in 17 patients without preoperative irrigation. 14 of these cases developed sepsis and were referred to ICU, 8 (31%) in the group with and 6 (35%) in the group without preparative irrigation. Between the two groups there were no significant differences in mortality, length of stay on ICU and total length of hospital stay. Conclusions: The results of our study provide no indication that the course of sepsis, associated with anastomotic leakage after laparoscopic colorectal surgery, is more severe in patients without preoperative bowel preparation, compared to those with bowel cleaning.

Cite this paper
G. Gubler, S. Dincler, J. Steurer and P. Buchmann, "Outcome of Anastomotic Leakage after Colorectal Surgery in Patients with or without Preoperative Mechanical Bowel Irrigation: An Observational Study," Surgical Science, Vol. 3 No. 3, 2012, pp. 105-110. doi: 10.4236/ss.2012.33021.

[1]   K. K. Guenaga, D. Matos and P. Wille-Jorgensen, “Mechanical Bowel Preparation for Elective Colorectal Surgery,” John Wiley & Sons, Ltd., Hoboken, 2008, p. CD001544.

[2]   P. Bucher, P. Gervaz, C. Soravia, B. Mermillod, M. Erne and P. Morel, “Randomized Clinical Trial of Mechanical Bowel Preparation versus No Preparation before Elective Left-Sided Colorectal Surgery,” British Journal of Surgery, Vol. 92, No. 4, 2005, pp. 409-414. doi:10.1002/bjs.4900

[3]   G. Gravante, R. Caruso, S. M. Andreani and P. Giordano, “Mechanical Bowel Preparation for Colorectal Surgery: A Meta-Analysis on Abdominal and Systemic Complications on Almost 5000 Patients,” International Journal of Colorectal Disease, Vol. 23, No. 12, 2008, pp. 1145-1150. doi:10.1007/s00384-008-0592-z

[4]   S. Scabini, E. Rimini, E. Romairone, R. Scordamaglia, G. Damiani, D. Pertile and V. Ferrando, “Colon and Rectal Surgery for Cancer without Mechanical Bowel Preparation: One-Center Randomized Prospective Trial,” World Journal of Surgical Oncology, Vol. 8, 2010, p. 35. doi:10.1186/1477-7819-8-35

[5]   P. Bucher, B. Mermillod, P. Gervaz and P. Morel, “Mechanical Bowel Preparation for Elective Colorectal Surgery: A Meta-Analysis,” Archives of Surgery, Vol. 139, No. 12, 2004, pp. 1359-1364. doi:10.1001/archsurg.139.12.1359

[6]   K. Lassen, M. Soop, J. Nygren, P. B. Cox, P. O. Hendry, C. Spies, M. F. von Meyenfeldt, K. C. Fearon, A. Revhaug, S. Norderval, O. Ljungqvist, D. N. Lobo and C. H. Dejong, “Consensus Review of Optimal Perioperative Care in Colorectal Surgery: Enhanced Recovery after Surgery (ERAS) Group Recommendations,” Archives of Surgery, Vol. 144, No. 10, 2009, pp. 961-969. doi:10.1001/archsurg.2009.170

[7]   J. V. Roig, A. Garcia-Fadrique, J. Garcia-Armengol, M. Bruna, C. Redondo, M. J. Garcia-Coret and P. Albors, “Mechanical Bowel Preparation and Antibiotic Prophylaxis in Colorectal Surgery: Use by and Opinions of Spanish Surgeons,” Colorectal Disease, Vol. 11, No. 1, 2009, pp. 44-48. doi:10.1111/j.1463-1318.2008.01542.x

[8]   H. Kehlet, M. W. Buchler, R. W. Beart Jr., R. P. Billingham and R. Williamson, “Care after Colonic Operation: Is It Evidence-Based? Results from a Multinational Survey in Europe and the United States,” Journal of the American College of Surgeons, Vol. 202, No. 1, 2006, pp. 45-54. doi:10.1016/j.jamcollsurg.2005.08.006

[9]   A. Mahajna, M. Krausz, D. Rosin, M. Shabtai, D. Hershko, A. Ayalon and O. Zmora, “Bowel Preparation Is Associated with Spillage of Bowel Contents in Colorectal Surgery,” Diseases of the Colon & Rectum, Vol. 48, No. 8, 2005, pp. 1626-1631. doi:10.1007/s10350-005-0073-1

[10]   R. C. Bone, W. J. Sibbald and C. L. Sprung, “The ACCP-SCCM Consensus Conference on Sepsis and Organ Failure,” Chest, Vol. 101, No. 6, 1992, pp. 1481-1483. doi:10.1378/chest.101.6.1481

[11]   C. Platell, N. Barwood and G. Makin, “Randomized Clinical Trial of Bowel Preparation with a Single Phosphate Enema or Polyethylene Glycol before Elective Colorectal Surgery,” British Journal of Surgery, Vol. 93, No. 4, 2006, pp. 427-433. doi:10.1002/bjs.5274

[12]   K. Holte, K. G. Nielsen, J. L. Madsen and H. Kehlet, “Physiologic Effects of Bowel Preparation,” Diseases of the Colon & Rectum, Vol. 47, No. 8, 2004, pp. 1397-1402. doi:10.1007/s10350-004-0592-1

[13]   B. Jung, O. Lannerstad, L. Pahlman, M. Arodell, M. Unosson and E. Nilsson, “Preoperative Mechanical Preparation of the Colon: The Patient’s Experience,” BMC Surgery, Vol. 7, 2007, p. 5. doi:10.1186/1471-2482-7-5

[14]   K. Slim, E. Vicaut, Y. Panis and J. Chipponi, “Meta-Analysis of Randomized Clinical Trials of colorectal Surgery with or without Mechanical Bowel Preparation,” British Journal of Surgery, Vol. 91, No. 9, 2004, pp. 1125-1130. doi:10.1002/bjs.4651