Bowel preparation is associated with spillage of bowel contents in colorectal surgery.
ABSTRACT Infectious complications pose a significant cause of morbidity in colon and rectal surgery. This study was designed to assess the effect of bowel preparation on spillage of bowel contents into the peritoneal cavity during colorectal surgery, and its potential effect on the rate of postoperative infectious complications.
The quality of bowel preparation and the incidence of spillage of bowel contents were prospectively assessed in patients undergoing elective colon and rectal resection. The patients were followed for 30 days for postoperative infectious and noninfectious complications.
A total of 333 patients were included in this study, of which 181 did not receive mechanical bowel preparation. Intraoperative spillage of bowel contents occurred in 48 patients (14 percent), whereas in 285 patients (86 percent), spillage did not occur. There was a trend toward a higher rate of overall surgical infectious and noninfectious complications in patients who had spillage of bowel contents compared with patients without spillage; however, this difference was not statistically significant (18.7 vs. 11 percent, and 29 vs. 19 percent, respectively). Preoperative mechanical bowel preparation and colocolonic or colorectal anastomosis was associated with a higher rate of bowel contents spillage, although this difference did not reach statistical significance. Liquid colonic contents caused significantly higher rates of spillage.
Spillage of bowel contents into the peritoneal cavity during colon and rectal surgery may increase the rate of postoperative infectious complications. In addition, inadequate mechanical bowel preparation, leading to liquid bowel contents, increases the rate of intraoperative spillage.
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ABSTRACT: A total of 149 patients admitted for elective colorectal surgery were randomly allocated to receive preoperative mechanical bowel preparation (group 1) or no mechanical bowel preparation (group 2). All patients received antimicrobial prophylaxis with cephalothin and metronidazole. The overall incidence of wound infection was 17.4 per cent (24 per cent for group 1, 12 per cent for group 2) and that of dehiscence 7.4 per cent (10 per cent for group 1, 5 per cent for group 2). The incidence of wound infection was significantly higher in group 1 (P < 0.05) but that of anastomotic dehiscence did not differ significantly between groups. Mechanical bowel preparation is unnecessary and may be harmful in terms of preventing wound infection and anastomotic dehiscence in patients undergoing elective colorectal surgery.British Journal of Surgery 12/1994; 81(11):1673-6. · 4.84 Impact Factor
- Annals of Surgery 07/1966; 163(6):838-49. · 6.33 Impact Factor
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ABSTRACT: The necessity of preoperative or intraoperative mechanical bowel preparation of the colon, before primary anastomosis, has been recently challenged in clinical elective and emergency situations. This experimental study in dogs investigated the safety of segmental resection and primary anastomosis in the unprepared or loaded colon. Two segments of the descended colon were resected and anastomosed in each animal. Group I (12 anastomoses) received preoperative mechanical bowel preparation; the colon was not prepared in Group II (16 anastomoses); in Group III (12 anastomoses), a preliminary distal colonic obstruction was produced, and during the subsequent resection the colon was loaded. Postoperatively, animals were observed clinically, and anastomoses were assessed at autopsy on the ninth day. All animals recovered uneventfully. At autopsy there was no evidence of anastomotic leakage. In light of recent clinical reports and this experimental study, the ritual of mechanical bowel preparation should be further scrutinized.Diseases of the Colon & Rectum 08/1995; 38(7):749-52; discussion 752-4. · 3.34 Impact Factor