Preoperative bowel preparation does not favor the management of colorectal anastomotic leak

Konstantinos A Zorbas; Daohai Yu; Aruj Choudhry; Howard M Ross; Matthew Philp

doi:10.4240/wjgs.v11.i4.218

Preoperative bowel preparation does not favor the management of colorectal anastomotic leak

World J Gastrointest Surg. 2019 Apr 27;11(4):218-228. doi: 10.4240/wjgs.v11.i4.218.

Authors

Konstantinos A Zorbas¹, Daohai Yu², Aruj Choudhry³, Howard M Ross³, Matthew Philp³

Affiliations

¹ Department of Surgery, BronxCare Health System, NY 10457, United States. zorbasko@gmail.com.
² Department of Clinical Sciences, Lewis Katz School of Medicine, Temple University, PA 19140, United States.
³ Department of Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, United States.

Abstract

Background: 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.

Aim: To determine the association between preoperative bowel preparation and postoperative anastomotic leak management (surgical vs non-surgical).

Methods: 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.

Results: 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 χ ² test of homogeneity was conducted and there was no statistically/clinically significant difference between the three categories of bowel preparation in terms of reoperation.

Conclusion: 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.

Keywords: Anastomotic leak; Bowel preparation; Colorectal anastomotic leak; Colorectal surgery; National Surgical Quality Improvement Program; Preoperative bowel preparation; Preoperative mechanical bowel preparation; Preoperative oral antibiotics.