Does using comprehensive preoperative bowel preparation offer any advantage for urinary diversion using ileum? A meta-analysis

Abstract

The aim of this study was to compare the efficacy of comprehensive bowel preparation to that of limited bowel preparation in prevention of postoperative complications in elective urinary diversion surgery by using ileum. Literature search of PubMed, EMBASE and the Cochrane Library was done to identify randomized controlled trials (RCTs) and cohort studies involving comparison of postoperative complications after comprehensive bowel preparation and limited bowel preparation. A meta-analysis was carried out to distinguish overall differences between the two groups. Our literature search yielded two randomized controlled trials and two cohort studies, involving a total of 346 patients, which met our inclusion criteria. There was no significant difference between the comprehensive bowel preparation and limited bowel preparation in wound infection [relative risk (RR) 95 % confidence interval (CI), 1.05(0.46-2.40); P = 0.86], mortality [RR 95 % CI, 1.06 (0.32-3.55); P = 0.76], ileus [RR 95 % CI, 0.86 (0.37, 2.00); P = 0.40], sepsis [RR 95 % CI, 0.71 (0.20, 2.52); P = 0.78], anastomotic leakage [RR 95 % CI, 0.81 (0.15, 4.21); P = 0.83], wound dehiscence [RR 95 % CI, 0.92 (0.40, 2.13); P = 0.67], peritonitis [RR 95 % CI, 0.64 (0.08, 5.10); P = 0.63] or fistula [RR 95 % CI, 0.71 (0.18,2.75); P = 0.63]. The limited evidence available demonstrated that the use of comprehensive bowel preparation for urinary diversion surgery using ileum does not offer any significant advantage over limited bowel preparation. Future work should target more high-quality RCTs to confirm this.