Elective intestinal operations in infants and children without mechanical bowel preparation: a pilot study.
ABSTRACT Preoperative mechanical bowel preparation (MBP) for elective intestinal operations has been a long accepted practice. However, MBP is often unpleasant and time-consuming for patients, and clinical trials in adults have not shown improved outcomes. We conducted this pilot study to test whether omitting MBP before elective intestinal operations in infants and children would increase the risk of infectious or anastomotic complications.
Retrospective review was performed of 143 patients who had an elective colon or distal small bowel procedure performed at our children's hospital between 1990 and 2003.
Thirty-three patients (No PREP) were managed by a single surgeon who routinely omitted MBP, whereas another 110 patients (PREP) were prepared with enemas, laxatives, or both. Both groups received 24 hours of preoperative dietary restriction to clear liquids and perioperative parenteral antibiotics. The No PREP group had one anastomotic leak and no wound infections, whereas the PREP group had 2 anastomotic leaks and 1 wound infection (P = .58). These results occurred despite greater duration of antibiotic therapy and incidence of delayed wound closures in the PREP group.
The results of this pilot study suggest that omitting MBP before elective intestinal operations in infants and children carries no increased risk of infectious or anastomotic complications. Eliminating MBP may reduce health care costs and inconvenience to patients. These findings warrant a large, prospective, randomized clinical trial to validate our findings and to investigate further the necessity of MBP in the pediatric population.
[Show abstract] [Hide abstract]
ABSTRACT: Mechanical bowel preps were initially thought to decrease the bacterial load of the colon and therefore decrease infection. Traditional bowel preps include osmotic, laxative, and combination regimen. Data demonstrate that mechanical bowel preps are generally equivalent; however, the addition of oral antibiotics may further reduce the risk of infection. Recent data suggest that mechanical bowel preparations may not be necessary, and that dietary restrictions before surgery may also be obsolete. In this review, the authors address the types of mechanical bowel preparations (MBPs), differences in outcomes between MBPs, the role of oral antibiosis and enemas, the benefits of no MBP, and dietary preparations for elective colon and rectal surgery.Clinics in Colon and Rectal Surgery 09/2013; 26(3):146-152. DOI:10.1055/s-0033-1351129
[Show abstract] [Hide abstract]
ABSTRACT: This goal of this review was to examine the clinical evidence in support of commonly utilized measures intended to reduce complications following elective colorectal surgery.Data sourceLiterature searches were performed to identify relevant studies from Medline, PubMed, and Cochrane databases.Study selectionThe American Pediatric Surgery Association Outcomes and Clinical Trials Committee selected eight questions to address this topic systematically in the context of three management areas: 1) appropriate utilization of systemic antibiotics for colorectal procedures, 2) reduction of stool burden through mechanical bowel preparation, and 3) intraluminal gut decontamination through use of enteral non-absorbable antibiotics. Primary outcomes of interest included the occurrence of infectious and mechanical complications related to stool burden and intraluminal bacterial concentration (incisional surgical site infection, anastomotic leakage, and intra-abdominal abscess).ResultsThe evidence in support of each management category was systematically reviewed, graded, and summarized in the context of the review’s primary outcomes. Practice recommendations were made as deemed appropriate by the Committee.Conclusions Clinical evidence in support of interventions to reduce infectious complications following colorectal surgery is derived almost exclusively from the adult literature. High-quality evidence to guide clinical practice in children is sorely needed, as the available data may have only limited relevance to pediatric colorectal diseases.Journal of Pediatric Surgery 11/2014; 50(1). DOI:10.1016/j.jpedsurg.2014.11.028 · 1.31 Impact Factor