Elective intestinal operations in infants and children without mechanical bowel preparation: A pilot study
Department of Surgery, Vanderbilt Children's Hospital, Vanderbilt University Medical Center, Nashville, TN 37203, USA. Journal of Pediatric Surgery
(Impact Factor: 1.39).
07/2005; 40(6):978-81; discussion 982. DOI: 10.1016/j.jpedsurg.2005.03.013
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.
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ABSTRACT: Guidelines regarding bowel preparation exist for the adult but not the pediatric population. Our aim was to evaluate the bowel preparation practices, including antibiotic usage for elective colorectal operations in children.
A survey was designed and administered to a nationwide group of pediatric surgeons to ascertain current practices of bowel preparation.
Four hundred ninety-three surveys were administered, and 136 physicians responded (28%). Mechanical bowel preparation was used by 96% of the respondents. Preoperative intravenous antibiotics were used by 99% of respondents. The number of years in practice did not significantly affect the use of oral antibiotics (P = .62) or the duration of intravenous antibiotics (P = .78).
There is a wide variation in bowel preparation practices in children. A prospective, randomized trial would be helpful to identify the role of oral antibiotics and optimal duration of intravenous antibiotics in this population.
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