Preoperative bowel preparation for pancreaticoduodenectomy: Is it necessary?

Abstract

279 Background: Preoperative bowel preparation (PBP) before pancreaticoduodenectomy (PD) is commonly performed; however, the effect of PBP on intraoperative fluid requirements and acute renal failure (ARF) after PD has not been reported. The goal of this study was to determine the effect of PBP on postoperative complications, intraoperative fluid requirements, and ARF after PD. Methods: In this retrospective sequential analysis, all patients undergoing PD consecutively from September 2005 to July 2012 by a single surgeon were identified. Clinical data from patients who received PBP from September 2005 to November 2008 was compared to those without PBP from December 2008 to July 2012. Results: In all, 140 consecutive patients were identified with 49 (35%) having received PBP. There was no significant difference in the frequency of chronic renal failure between groups. The PBP group received a larger total intraoperative fluid volume (9.33 vs 6.54 L, p<0.001) and had a higher incidence of postoperative ARF (22.4% vs. 5.4%, p = 0.003) compared to those without PBP. There was no significant difference in the rates of superficial, deep, or organ space surgical site infections between the two groups. Additionally, there was no significant difference in the rates of pancreatic leak, other GI tract leak, or postoperative ileus between the groups. Conclusions: Surgical site infections are not significantly reduced with PBP prior to PD. In contrast, PBP is associated with a 2.8 L increase in intraoperative fluid administration and a 17% increase in the incidence of postoperative ARF. Thus, PBP should not be offered routinely prior to pancreaticoduodenectomy. [Table: see text]