Abstract
SummaryBackgroundRecent studies support the use of mechanical bowel preparation and/or oral antibiotic prophylaxis in patients operated on for Crohn’s disease (CD); however, data are scarce, especially for laparoscopic surgery. Therefore, this study was carried out to investigate the effect of laparoscopic surgery on complication rates in patients not undergoing standardized bowel preparation but single shot antibiotics.MethodsIn this study 255 consecutive patients who underwent a laparoscopic intestinal resection for CD at a tertiary referral center between 1997 and 2014 were retrospectively analyzed. Superficial surgical site infections (SSI), organ/space infections and ileus were recorded and grouped according to the type of resection (colorectal vs. small intestine ± ileocecal).ResultsThe baseline characteristics of the groups were comparable. Colorectal resections showed a significantly increased risk of organ/space infection (4.6% in small intestine ± ileocecal vs. 14.3% in colorectal resections p = 0.039). The superficial SSI rate was low in both groups (1.8% in small intestine ± ileocecal resection vs. 0% in colorectal resections, p = 1.000). Univariate binary logistic regression analysis revealed a statistically significant influence of duration of surgery (p = 0.001) and type of resection (p = 0.031) on organ/space infection. In multivariate analysis, only duration of surgery (OR 1.111, 95% CI 1.026–1.203 for every 10 min, p = 0.009) remained significant for postoperative organ/space infections.ConclusionsSingle-shot antibiotic therapy without bowel preparation is safe in patients undergoing minimally invasive surgery and was associated with a low number of complications; however, organ/space infections were more common if colorectal resections were performed. Therefore, combined bowel preparation might be beneficial when the (sigmoid) colon or rectum are involved.
Highlights
There is an ongoing debate among colorectal surgeons about the use of bowel preparation and oral administration of non-absorbable antimicrobial agents prior to surgery, despite clear recommendations by recent guidelines [1]
These assumptions are in line with a large recently published study that did not find any additional benefit in mechanical preparation compared to antibiotic prophylaxis alone the day before colorectal surgery [10]
Due to the lack of data the present study was conducted to assess the safety of no bowel preparation on the outcome of laparoscopic surgery in Crohn’s disease (CD) and identify potential subgroups that might benefit from combined bowel preparation in the future
Summary
There is an ongoing debate among colorectal surgeons about the use of bowel preparation and oral administration of non-absorbable antimicrobial agents prior to surgery, despite clear recommendations by recent guidelines [1]. Investigators in the past did not find any beneficial effects [2], recent evidence from large studies has shown that combined bowel preparation can significantly reduce surgical site in- K. The majority of patients suffer from diarrhea and significant stenosis at the time of presentation [9], mechanical bowel preparation may be contraindicated These assumptions are in line with a large recently published study that did not find any additional benefit in mechanical preparation compared to antibiotic prophylaxis alone the day before colorectal surgery [10]. Laparoscopy is conducted whenever possible and has proven to be safe, even in penetrating CD [12] This potentially leads to a significantly reduced rate of SSI irrespective of additional bowel preparation. Due to the lack of data the present study was conducted to assess the safety of no bowel preparation on the outcome of laparoscopic surgery in CD and identify potential subgroups that might benefit from combined bowel preparation in the future
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