Can mechanical bowel preparation with oral antibiotics reduce surgical site infection and anastomotic leakage rates following elective colorectal resections?

Abstract

Background: Surgical site infection(SSI) and anastomotic leakage are major causes of morbidity after colorectal resections. Mechanical bowel preparation (MBP) combined with oral antibiotics (OAs) was considered to reduce SSI and anastomotic leakage. Purpose: This study analyzed the influence of oral antibiotic use together with MBP on SSI, anastomotic leakage rate and length of hospital stays in patients with elective colorectal surgery. Materials and Methods: From January 2013 to December 2015, 321 patients who underwent elective colorectal resections with complete bowel preparation were included in the study. All patients received MBP. Patients in group A did not receive OAs, whereas patients in group B received OAs. Exclusion criteria were emergent operation, colonoscopy, colostomy or closure of colostomy and received preoperative chemoradiotherapy. The outcome measured was SSI, anastomotic leakage and prophylactic colostomy. Results: Of 321 patients, group A (n =122) and group B (n =199), both groups had similar age, gender, localization and stage of the disease, underlying disease, prophylactic stomy and operation time. Patients receiving OAs with MBP didn't demonstrated a lower rate of SSI and lower leakage rate after multivariate logistic analysis. Conclusions: OAs with MBP prior to elective colorectal resection was no better than MBP only on reducing SSI and anastomotic leakage rates. And OAs will increase patients uncomfortable and GI function side effect. Therefore, MBP alone might be enough colon prepare and higher compliance for the patients.