PWE-255 An unresolved issue: mechanical bowel preparation for left sided colorectal surgery

Abstract

Introduction This study was undertaken to assess the potential benefit of undertaking a mechanical bowel preparation when looking purely at a population of patients undergoing surgery for a left sided colorectal cancer. Method Retrospective data from October 2010 to October 2011 on left sided colorectal cancers was obtained from the colorectal cancer databases and case notes. Patients were allocated to one of 9 colorectal surgeons by chance. Each surgeon had a practice of either MBP or phosphate enema (PE) pre-operatively. Leak rate, comprising clinical and radiological leaks, and complications were measured. Results One hundred and thirty-three patients were identified. There were 23 anastomotic leaks (19 radiologically detected and 4 clinically), of which 12 received MBP and 11 no-MBP. The anastomotic leak rate (MBP group vs. no-MBP group; 30.0% vs. 11.8% p = 0.011) and 30 day morbidity (MBP group vs. no-MBP group; 50.0% vs. 32.3% p = 0.171) were higher in the MBP group. A strong association was found with MBP and at least 1 surgical site infection, 35.0% (MBP) vs. 16.1% (no-MBP) p = 0.016. As expected, surgical height of the tumour was found to be a predictor for anastomotic leak with 39.5% (below the peritoneal reflection) vs. 6.7% (above the peritoneal reflection) p = 0.001. There was no difference in 30 day mortality between the 2 groups, MBP −2.5%, no-MBP −3.2%. Conclusion The results of this study do not show any advantage with pre-operative MBP in left sided colorectal cancer surgery. Disclosure of interest None Declared. References Bretagnol F, et al . Rectal cancer surgery with or without bowel preparation: The French GRECCAR III multicenter single-blinded randomized trial. Ann Surg. 2010;252(5):863–8 NPSA. Rapid Response Report : Reducing risk of harm from oral bowel cleansing solutions . 2009 13/08/2014]; Available from: http://www.npsa.nhs.uk/corporate/news/new-guidance-following-laxative-errors-in-nhs/ Contant CM, et al . Mechanical bowel preparation for elective colorectal surgery: a multicentre randomised trial. Lancet. 2007;370(9605):2112–7 Gustafsson UO, et al . Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS(R)) Society recommendations. Clin Nutr. 2012;31(6):783–800 Slim K, et al . Updated systematic review and meta-analysis of randomized clinical trials on the role of mechanical bowel preparation before colorectal surgery. Ann Surg. 2009;249(2):203–9