Preoperative Bowel Preparation Research Articles

Risk Factors Asscociated with Hypokalemia during Postanesthesia Recovery and Its Impact on Outcomes in Gynecological Patients: A Propensity Score Matching Study.

This study aimed to explore the risk factors and outcomes of hypokalemia during the recovery period from anesthesia in the gynecological population. This retrospective cohort study included 208 patients who underwent gynecological surgery at our institution between January 2021 and March 2022. Data were collected for each patient, including demographics, disease status, surgical data, and clinical information. Preoperative bowel preparation, postoperative gastrointestinal function, and electrolyte levels were compared between the two groups using propensity score matching (PSM). The incidence of hypokalemia (serum potassium level <3.5 mmol/L) during the recovery period from anesthesia was approximately 43.75%. After PSM, oral laxative use (96.4% vs. 82.4%, P=0.005), the number of general enemas (P=0.014), and the rate of ≥2 general enemas (92.9% vs. 77.8%, P=0.004) were identified as risk factors for hypokalemia, which was accompanied by decreased PaCO2 and hypocalcemia. There were no significant differences in postoperative gastrointestinal outcomes, such as the time to first flatus or feces, the I-FEED score (a scoring system was created to evaluate impaired postoperative gastrointestinal function), or postoperative recovery outcomes, between the hypokalemia group and the normal serum potassium group. Hypokalemia during postanesthesia recovery period occurred in 43.75% of gynecological patients, which resulted from preoperative mechanical bowel preparation; however, it did not directly affect clinical outcomes, including postoperative gastrointestinal function, postoperative complications, and length of hospital stay.

The effect of preoperative mechanical bowel preparation in paediatric bowel surgery on postoperative wound related complications: A meta-analysis.

Mechanical bowel preparation (MBP), a routine nursing procedure before paediatric bowel surgery, is widely should in clinical practice, but its necessity remains controversial. In a systematic review and meta-analysis, we evaluated the effect of preoperative MBP in paediatric bowel surgery on postoperative wound-related complications in order to analyse the clinical application value of MBP in paediatric bowel surgery. As of November 2023, we searched four online databases: the Cochrane Library, Embase, PubMed, and Web of Science. Two investigators screened the collected studies against inclusion and exclusion criteria, and ROBINS-I was used to evaluate the quality of studies. Using RevMan5.3, a meta-analysis of the collected data was performed, and a fixed-effect model or a random-effect model was used to analyse OR, 95% CI, SMD, and MD. A total of 11 studies with 2556 patients were included. Most of studies had moderate-to-severe quality bias. The results of meta-analysis showed no statistically significant difference in the incidence of complications related to postoperative infections in children with MBP before bowel surgery versus those with No MBP, wound infection (OR 1.11, 95% CI:0.76 ~ 1.61, p = 0.59, I2 = 5%), intra-abdominal infection (OR 1.26, 95% CI:0.58 ~ 2.77, p = 0.56, I2 = 9%). There was no significant difference in the risk of postoperative bowel anastomotic leak (OR 1.07, 95% CI:0.68 ~ 1.68, p = 0.78, I2 = 12%), and anastomotic dehiscence (OR 1.67, 95% CI:0.13 ~ 22.20, p = 0.70, I2 = 73%). Patients' intestinal obstruction did not show an advantage of undergoing MBP preoperatively, with an incidence of intestinal obstruction (OR 1.95, 95% CI:0.55 ~ 6.93, p = 0.30, I2 = 0%). Based on existing evidence that preoperative MBP in paediatric bowel surgery did not reduce the risk of postoperative wound complications, we cautiously assume that MBP before surgery is unnecessary for children undergoing elective bowel surgery. However, due to the limited number of study participants selected for this study and the overall low quality of evidence, the results need to be interpreted with caution. It is suggested that more high quality, large-sample, multicenter clinical trials are required to validate our findings.

Colon stenting as a bridge to surgery in obstructive colorectal cancer management.

Colonic stent placement is a commonly used bridging strategy for surgery in patients with obstructive colorectal cancer. The procedure involves the placement of a self-expandable metallic stent (SEMS) across the obstructive lesion to restore intestinal patency and alleviate the symptoms of obstruction. By allowing patients to receive surgery in a planned and staged manner with time for preoperative optimization and bowel preparation, stent placement may reduce the need for emergency surgery, which is associated with higher complication rates and poorer outcomes. This review focuses on the role of colon stenting as a bridge to surgery in the management of obstructive colorectal cancer. SEMS as a bridge to surgery for left-sided colon cancer has been demonstrated to be particularly useful; however, further research is needed for its application in cases of right-sided colon cancer. Colon stent placement also has limitations and potential complications including stent migration, re-obstruction, and perforation. However, the timing of curative surgery after SEMS placement remains inconclusive. Considering the literature to date, performing surgery at an interval of approximately 2 weeks is considered appropriate. Therefore, colonic stent placement may be an effective strategy as a bridge to surgery in patients with obstructive colorectal cancer.

The association of hernia-specific and procedural risk factors with early complications in ventral hernia repair: ACHQC analysis

BackgroundMany surgical risk assessment tools emphasize patient-specific risk factors. Our objective was to use a hernia-specific database to assess risk factors of complications in ventral hernia repair (VHR) focusing on hernia-specific and procedural factors. MethodsThe ACHQC database was queried for elective VHR in adults from 2012 to 2023. Primary outcome was overall 30-day complications. Multivariable logistic regression was used for analysis. Results41,526 VHR were included. The rate of 30-day complications was 18%, surgical site infection 3%, surgical site occurrence requiring procedural intervention 4%, readmission 4%, reoperation 2%, and mortality 0.2%. Multivariable analysis demonstrated that BMI, ASA, frailty, COPD, anticoagulants, defect width, incisional and recurrent hernias, presence of stoma or prior mesh, prior abdominal wall infection, non-clean wound, operative time, open approach and myofascial release were associated with 30-day complications (OR ​= ​1.01–1.66). Preoperative chlorhexidine, bowel preparation and fascial closure were associated with lower complication risk (OR ​= ​0.70–0.89). ConclusionHernia and procedural risk factors are associated with early complications following elective VHR. These factors need to be included in surgical risk assessment tools, to supplement patient-specific factors.

Laxatives in Geriatric Practice: From Preoperative Bowel Preparation to Correction of Chronic Constipation

The first part of  the article discusses the issues of  preoperative bowel preparation in  older and oldest-old patients, with a  particular emphasis on  the safest drugs. The second part of  the article presents the problem of  chronic constipation as a geriatric syndrome, including a description of age-associated changes in the structure and function of colon, causes of constipation and features of correction in geriatric practice.

A clinical study to evaluate the efficacy of Arishtaka enema in Pre-Operative Bowel Preparation - A Case Series

Bowel preparation before surgery refers to the removal of bowel contents via mechanical cleansing with oral or rectal measures. The proposed benefits are reduced rate of surgical site infections and easier manipulation of the bowel during surgery. An ideal bowel-cleansing agent should be well tolerated by subjects, easily administered, inexpensive and produce adequate clearance. The most extensively used enema agent is soap but due to its chemical constituents it is known to cause various side effects like nausea, gastric irritation, pain, etc. In Ayurveda, Acharya Sushrutha suggests patients are to be Nivrutta Vega i.e., free from natural urges prior to the surgery. Also, the drug Arishtaka seems to have the Rechaka, natural cleansing, non-allergic and surfactant properties. Considering these qualities, a preliminary attempt was made to study the effect of Arishtaka in bowel preparation. In the current study it has shown effective results and adequate quality of bowel preparation.

Implementation and achievements of enhanced recovery after surgery program in perioperative management of gastric cancer patients†

Abstract Objective The enhanced recovery after surgery (ERAS) program is less implemented in gastric cancer patients. The purpose of this survey is to investigate the implementation status of ERAS in perioperative period in gastric cancer. Methods This clinical observational study enrolled 329 patients between January 2020 and August 2020 in a single gastric cancer center. The questionnaire consisted of 4 parts: basic information, preoperative status, intraoperative status, and postoperative status of ERAS implementation in gastric cancer surgery. Results In the preoperative period, patients’ education and counseling (100%) were well adopted. Smoking cessation (34.6%), drinking cessation (36.9%), avoidance of preoperative mechanical bowel preparation (24.3%), respiratory function training (11.2%), and administration of carbohydrate-rich drink before surgery (0.6%) were relatively not well adopted. During the operation, maintenance of intraoperative normothermia and fluid management (100%), as well as epidural analgesia (81.5%), were well adopted. Thromboprophylaxis was performed in 133 (40.4%) patients. In the postoperative period, early active mobilization was implemented about 9.5 h, and early ambulation was implemented about 39.5 h, after surgery. A total of 140 (42.5%) patients received prolonged prophylactic antibiotics; 268 (81.5%) patients were provided diet upon gas passage; and 320 (97.3%) patients received intravenous fluid administration more than 5 d after surgery. The practice rate of early removal of urinary catheter (0%) and nasogastric tube (15.5%) was relatively low. A total of 11 (3.3%) patients experienced postoperative complication, and 1 (0.3%) patient received unplanned reoperation. The average costs were ¥59,500, and the average hospital stay was 12 (5, 36) d. Conclusions Standard perioperative management of ERAS program in gastric cancer surgery in China still requires improvement.

Incidence of Infection-related Complications and Optimal Saline Irrigation Volume for Preoperative Bowel Preparation to Reduce Postoperative Infections in Hirschsprung’s Disease

Objective: The purpose of this study was to find incidence of infection-related complications and the optimal volume and duration (days) of rectal NSS irrigation that would result in the low post-operative complications following transanal endorectal pull-through (TERPT) in patients with Hirschprung’s disease. Materials and Methods: We conducted a retrospective chart reviews of 131 patients diagnosed with Hirschsprung’s disease who underwent TERPT at Siriraj Hospital between January 2006 and December 2020. Results:  Infection-related complications were observed in 23(17.6%) patients, comprising 22(16.8%) cases of anastomotic strictures, 3(2.3%) cases of anastomotic leakages, and 2(1.5%) cases of intraabdominal collections. The median (Q1, Q3) volume of NSS irrigation (ml/kg/day) for those without complications (38.1 (33.9,50)) and those with complications (39.5 (35,45)) was statistically identical (p = 0.945). Similary, the median duration of for both groups was the same (p = 0.854). The mean (SD) volume of irrigated NSS in those with leakage (55.6 (32.7)) and those without leakage (44.3 (17.9)) showed no statistically significant difference (p = 0.291). Patients with post-operative stricture received the same amount of irrigated NSS (40.7 (11.9)) as those without stricture (45.4 (19.2)) (p = 0.138). Similarly, those with hyponatremia received the same amount of irrigated NSS as those without hyponatrema (p = 0.475). Conclusion: The volume of rectally irrigated NSS did not correlate with infection-related complications such as anastomotic leakage, stricture and intraabdominal collection. However, this study observed a low complication rate, thus, future research should cover a larger population.

International Variations in Surgical Morbidity and Mortality Post Gynaecological Oncology Surgery: A Global Gynaecological Oncology Surgical Outcomes Collaborative Led Study (GO SOAR1).

Gynaecological malignancies affect women in low and middle income countries (LMICs) at disproportionately higher rates compared with high income countries (HICs) with little known about variations in access, quality, and outcomes in global cancer care. Our study aims to evaluate international variation in post-operative morbidity and mortality following gynaecological oncology surgery between HIC and LMIC settings. Study design consisted of a multicentre, international prospective cohort study of women undergoing surgery for gynaecological malignancies (NCT04579861). Multilevel logistic regression determined relationships within three-level nested-models of patients within hospitals/countries. We enrolled 1820 patients from 73 hospitals in 27 countries. Minor morbidity (Clavien-Dindo I-II) was 26.5% (178/672) and 26.5% (267/1009), whilst major morbidity (Clavien-Dindo III-V) was 8.2% (55/672) and 7% (71/1009) for LMICs/HICs, respectively. Higher minor morbidity was associated with pre-operative mechanical bowel preparation (OR = 1.474, 95%CI = 1.054-2.061, p = 0.023), longer surgeries (OR = 1.253, 95%CI = 1.066-1.472, p = 0.006), greater blood loss (OR = 1.274, 95%CI = 1.081-1.502, p = 0.004). Higher major morbidity was associated with longer surgeries (OR = 1.37, 95%CI = 1.128-1.664, p = 0.002), greater blood loss (OR = 1.398, 95%CI = 1.175-1.664, p ≤ 0.001), and seniority of lead surgeon, with junior surgeons three times more likely to have a major complication (OR = 2.982, 95%CI = 1.509-5.894, p = 0.002). Of all surgeries, 50% versus 25% were performed by junior surgeons in LMICs/HICs, respectively. We conclude that LMICs and HICs were associated with similar post-operative major morbidity. Capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention.

Preoperative bowel preparation promotes intestinal functional recovery after esophagectomy.

Patients are prone to intestinal dysfunction after esophagectomy. The value of preoperative bowel preparation before esophagectomy is controversial. There is a lack of evidence as to whether preoperative bowel preparation can help patients improve bowel function and shorten the recovery time of bowel function. The objectives of this study were to explore whether preoperative bowel preparation can promote the recovery of intestinal function after esophagectomy. We analysed 139 patients who underwent elective radical esophagectomy in the Department of Thoracic Surgery at the Second Affiliated Hospital of Xi'an Jiaotong University from May 2016 to December 2018. The enrolled patients were divided into the study group (bowel preparation group) and the control group (no bowel preparation group) of 71 cases and 68 cases. Patients in the study group were given dissolved polyethylene glycol electrolyte powder and a cleansing enema the day before surgery. Patients in the control group were neither given polyethylene glycol electrolyte powder nor cleansing enemas before surgery. The postoperative recovery of the two groups were compared. Postoperative bed rest time, bowel function recovery time and the time of first flatus and defecation after surgery were significantly shorter in patients with bowel preparation than in those without bowel preparation, and the differences were statistically significant. (P=0.038, P<0.001, P<0.001, P<0.001; respectively). Preoperative bowel preparation can promote the recovery of patients with esophageal cancer, especially the recovery of bowel function, which can reduce the pain caused by abdominal distension and improve the quality of life of patients.

Time required for indocyanine green fluorescence emission for evaluating bowel perfusion in left-sided colon and rectal cancer surgery.

Indocyanine green fluorescence imaging (ICG-FI) has been reported to be useful in reducing the incidence of anastomotic leakage (AL) in colectomy. This study aimed to investigate the correlation between the required time for ICG fluorescence emission and AL in left-sided colon and rectal cancer surgery using the double-stapling technique (DST) anastomosis. This retrospective study included 217 patients with colorectal cancer who underwent left-sided colon and rectal surgery using ICG-FI-based perfusion assessment at our department between November 2018 and July 2022. We recorded the time required to achieve maximum fluorescence emission after ICG systemic injection and assessed its correlation with the occurrence of AL. Among 217 patients, AL occurred in 21 patients (9.7%). The median time from ICG administration to maximum fluorescence emission was 32s (range 25-58s) in the AL group and 28s (range 10-45s) in the non-AL group (p < 0.001). The cut-off value for the presence of AL obtained from the ROC curve was 31s. In 58 patients with a required time for ICG fluorescence of 31s or longer, the following risk factors for AL were identified: low preoperative albumin [3.4mg/dl (range 2.6-4.4) vs. 3.9mg/dl (range 2.6-4.9), p = 0.016], absence of preoperative mechanical bowel preparation (53.8% vs. 91.1%, p = 0.005), obstructive tumor (61.5% vs. 17.8%, p = 0.004), and larger tumor diameter [65mm (range 40-90) vs. 35mm (range 4.0-100), p < 0.001]. The time required for ICG fluorescence emission was associated with AL.

Comparison of Enhanced Recovery After Surgery (ERAS) Pathway Versus Standard Care in Patients Undergoing Elective Stoma Reversal Surgery- A Randomized Controlled Trial

BackgroundPractices such as prolonged preoperative fasting, bowel preparation, delayed ambulation and resumption of orals result in morbidity in 15-20% of stoma reversal cases which can be improved by Enhanced Recovery After Surgery (ERAS) pathways. AimTo evaluate the safety, feasibility and efficacy of ERAS pathway in patients undergoing elective loop ileostomy or colostomy reversal surgery MethodsThis was an open-labeled, superiority randomized controlled trial in which patients undergoing loop ileostomy or colostomy reversal were randomized to standard or ERAS care. Patients with ASA class ≥3, needing laparotomy for stoma reversal, cardiac, renal and neurological illnesses were excluded. Components of ERAS protocol included pre-operative carbohydrate loading, avoidance of mechanical bowel preparation, goal directed fluid therapy, avoidance of long-acting opioid anesthetics or analgesics, avoidance of drains, urinary catheter or nasogastric tube, early mobilization and early enteral feeding. The primary outcome was length of stay (LOS) while the secondary outcomes were postoperative recovery and morbidity parameters. ResultsForty patients each were randomized to standard care and ERAS. Demographic and laboratory parameters between the two groups were comparable. ERAS group patients had significantly reduced LOS (5.3±0.3 vs 7 ± 2.6; mean difference: 1.73 ± 0.98; p=0.0008). Functional recovery was earlier in the ERAS group compared to the standard care group, such as early resolution of ileus (median-2 days; p<0.001), time to first stool (median-3 days; p=0.0002), time to the resumption of liquid diet (median-3 days; p<0.001) and solid diet (median-4 days; p<0.001). Surgical site infections (SSI) were significantly lesser in ERAS group (12.5% vs 32.5%; p=0.03) while postoperative nausea/vomiting (p=0.08), pulmonary complications (p=0.17) and urinary tract infections (p=0.56) were comparable in both groups. ConclusionERAS pathways are feasible, safe and significantly reduces LOS in patients undergoing elective loop ileostomy or colostomy reversal surgery.

Analysis of risk factors for surgical site infection after colorectal surgery: a cross-sectional study in the east of China pre-COVID-19.

The occurrence of surgical site infection (SSI) can prolong the postoperative hospital stay, increase the economic burden of patients, and even endanger their lives. The purpose of this study was to investigate the incidence, risk factors, and microbiology of SSI after colorectal surgery (CRS) and to provide a basis for the prevention and control of SSI. A single-center, prospective, cross-sectional study of adult patients undergoing CRS was conducted from 2010-2019. Univariate and multivariate logistic regression models were used to collect and analyze demographic information, hospital characteristics, and potential perioperative risk factors of SSI. A total of 3,302 eligible patients were included in this study, with 213 cases experiencing SSIs, resulting in an infection rate of 6.45%. Notably, the incidence of SSI decreased from 13.33% in 2010 to 3.56% in 2019 (Ptrend < 0.001). Escherichia coli accounted for the majority of isolated microorganisms (37.09%), with 49 strains exhibiting resistance to one or more antibiotics (35.25%). Multivariate analysis showed that diabetes, anastomosis leakage, wound classification (contaminated/dirty), operation duration, blood loss greater than 200 ml, and NNIS risk index score for 2 or 3 were independent risk factors. Conversely, laparoscopic approach, preoperative bowel preparation and preoperative albumin levels emerged as protective factors against SSI after CRS. Furthermore, compared to non-SSI patients, SSI patients had a significantly higher 30-day mortality rate following surgery (0.23% vs. 2.35%, p < 0.05). SSI after CRS was susceptible to many factors, and the pathogen of SSI was mainly Escherichia coli. In clinical practice, measures such as correcting preoperative hypoproteinemia, choosing laparoscopic surgery, preoperative bowel preparation and shortening the duration of surgery should be taken to reduce the incidence of SSI.

Elucidating colorectal cancer-associated bacteria through profiling of minimally perturbed tissue-associated microbiota.

Sequencing-based interrogation of gut microbiota is a valuable approach for detecting microbes associated with colorectal cancer (CRC); however, such studies are often confounded by the effect of bowel preparation. In this study, we evaluated the viability of identifying CRC-associated mucosal bacteria through centimeter-scale profiling of the microbiota in tumors and adjacent noncancerous tissue from eleven patients who underwent colonic resection without preoperative bowel preparation. High-throughput 16S rRNA gene sequencing revealed that differences between on- and off-tumor microbiota varied considerably among patients. For some patients, phylotypes affiliated with genera previously implicated in colorectal carcinogenesis, as well as genera with less well-understood roles in CRC, were enriched in tumor tissue, whereas for other patients, on- and off-tumor microbiota were very similar. Notably, the enrichment of phylotypes in tumor-associated mucosa was highly localized and no longer apparent even a few centimeters away from the tumor. Through short-term liquid culturing and metagenomics, we further generated more than one-hundred metagenome-assembled genomes, several representing bacteria that were enriched in on-tumor samples. This is one of the first studies to analyze largely unperturbed mucosal microbiota in tissue samples from the resected colons of unprepped CRC patients. Future studies with larger cohorts are expected to clarify the causes and consequences of the observed variability in the emergence of tumor-localized microbiota among patients.

Incidence rate of hypokalemic and its associated factors for patients undergoing noncardiac surgery: a retrospective analysis.

Hypokalemia is common in hospitalized patients. In fact, untreated hypokalemia is associated with the incidence and mortality of adverse cardiac events. Timely recognition and treatment of these diseases are essential. Indeed, a little research has been conducted on the level of K+ in perioperative patients. In this study, by comparing the changes of K+ from when patients were admitted to hospital and to after they had entered the operating room, we analyzed the related factors of K+ disorder after operating-room entry and identified factors related to the occurrence of perioperative K+ disorder. This single-center retrospective study included non-cardiac surgery patients who underwent admission blood gas analysis and blood gas analysis upon entering the operating room in the China-Japan Union Hospital of Jilin University between June 2019 and September 2020. Among the 258 patients who underwent non-cardiac surgery with anesthesia, 19 cases (7.4%) were hypokalemic on admission, and 102 cases (39.5%) were hypokalemic after admission to the operating room. The K+ levels after operating-room entry were positively correlated with the K+ concentration at admission (r=0.363; P<0.05). Female sex [odds ratio (OR) =0.451; 95% CI: 0.263-0.775; P=0.004], hypertension (OR =0.499; 95% CI: 0.281-0.885; P=0.017), and preoperative bowel preparation (OR =0.471; 95% CI: 0.258-0.860; P=0.014) were risk factors for hypokalemia for patients after operating-room entry. Hypokalemia was found to be common in patients after operating-room entry. Even patients with normal K+ at admission could have hypokalemia due to undergoing an operation, with female sex, hypertension, and bowel preparation being the risk factors for this condition.

Preoperative oral antibiotic bowel preparation regimens in radical cystectomies with continent diversion.

e16610 Background: Bowel preparation regimens (BRs) were historically standard before radical cystectomy (RC) with urinary diversion to decrease infection and anastomotic breakdown. However, the Enhanced Recovery After Surgery protocol (ERAS) no longer includes BRs. Recent data show that BRs may exacerbate frailty, worsen surgical outcomes, and prolong recovery. Importantly, however, previous studies did not stratify by diversion type. We performed a population-based analysis of preoperative oral antibiotic BRs (OABRs) with RC, alongside subgroup analyses to compare outcomes by diversion type. Methods: RCs performed from 2019-2020 were identified using the new NSQIP Cystectomy-Targeted PUF. Captured variables included OABR, diversion type, demographics, comorbidities, and perioperative outcomes. Univariate analysis with two tailed chi square and t tests was performed to compare baseline characteristics, 30-day mortality, and complications. Multivariable logistic regression with stepwise-backward-elimination (p &gt; 0.25) adjusted for mechanical BRs, operative approach, comorbidities, functional status, demographics, ASA class, labs, and staging. Results: In total, 3,894 RCs were performed, of which 357 (9.2%) included OABR. There were no significant baseline differences between the OABR and the non-OABR cohorts. On univariate analysis, OABR patients had increased operative time, length of stay (LOS), minor complications, and bleeds. On subgroup analysis, ileal conduit patients experienced higher rates of the 4 aforementioned outcomes plus deep wound infections and NGT use. However, the continent diversion subgroup was not associated with increased operative time, LOS, or any complications. Continent diversion had significantly lower rates of sepsis and ureteral fistula formation. Upon multivariable adjustment, OABR was not associated with increased rates of any complications across any subgroup. OABR did confer significantly decreased odds of sepsis in continent diversion patients. Conclusions: Supporting ERAS recommendations, this study showed that pre-RC OABRs do not improve outcomes and increase LOS for ileal conduits. However, this study uniquely included continent diversions, such as neobladders and Indiana pouches. Importantly, in continent diversion patients, OABR did not increase LOS or complications while decreasing sepsis rates. These findings suggest possible utility of OABR before RC with continent diversion.

Early Surgical Complications Following Transanal Endorectal Pull-through for Hirschsprung’s Disease

Objective: The purpose of this study was to examine factors affecting early complications following transanal endorectal pull-through (TERPT) in  patients with Hirschprung’s disease. Materials and Methods: Retrospective chart reviews of  patients with Hirschsprung’s disease who underwent TERPT/ abdominal assisted TERPT at Siriraj Hospital between January 2009 and  December 2019 was carried out. . Results: The overall complication rate was 26% (43/163). The complications were as follows:  14 cases of anastomotic strictures (32.6%), five cases of abscess at anastomosis (11.6%), and three cases of anastomotic leakages (7.0%). In regards to preoperative bowel preparation,  when comparing  those with and those without post-operative complications, the amount of NSS for rectal irrigation (ml/Kg), duration required (days), and duration of changed diet (days) were the same. Colostomy prior to a  pull-through operation could not prevent post-operative complications following endorectal pull-through (p = 1.000). The incidences of early complications following TERPT and  abdominal assisted TERPT was  the same (p = 0.344). Abdominal assisted TERPT had a higher incidence (4%) of anastomotic leakages whereas TERPT had a higher rate of anastomosis strictures (12%) compared to o abdominal assisted TERPT (5%). The higher the transitional zone, the higher the complication rate. Anastomotic leakages, the most serious complication, rarely occurred following TERPT in the  low transitional zone. Conclusion: There was no significant risk factor associated with early surgical complications following TERPT. Abdominal assisted TERPT should be selected properly according to the  level of transitional zone. The complications correlate with whether a perfect pull-through operation could be performed or not.

Effect of preoperative oral antibiotics and mechanical bowel preparation on the prevention of surgical site infection in elective colorectal surgery, and does oral antibiotic regime matter? a bayesian network meta-analysis.

Surgical site infection (SSI) impacts 5-20% of patients after elective colorectal surgery. There are varying reports on the effectiveness of oral antibiotics (OAB) with preoperative mechanical bowel preparation (MBP) in preventing SSI. We aim to determine the role of OAB and MBP in preventing SSI after elective colorectal surgery. We also determine if a specific OAB regimen will be more effective than others. This study investigated the impact of OAB and MBP in patients undergoing elective colorectal surgery. PubMed, MEDLINE, Ovid, Cochrane Central Register of Controlled Trials, ACP Journal Club, and Embase databases were searched for randomized clinical trials (RCTs) published by June 2022. All RCTs comparing various preoperative bowel preparation regimens, including pairwise or multi-intervention comparisons, were included. To establish the role of OAB and MBP in preventing SSI, we conducted a Bayesian network meta-analysis on all RCTs. We further performed subgroup analysis to determine the most effective OAB regimen. Among included 46 studies with a total of 12690 patients, patients in the MBP + OAB group were less likely to have SSI than those having MBP-only (OR 0.55, 95% CrI 0.39-0.76), and without MBP and OAB (OR 0.52, 95% CrI 0.32-0.84). OAB regimen C (kanamycin + metronidazole) and A (neomycin + metronidazole) demonstrated a significantly reduced incidence of SSI, compared to regimen B (neomycin + erythromycin) with OR 0.24 (95% CrI 0.07-0.79) and 0.26 (95% CrI 0.07-0.99) respectively. OAB with MBP reduces the risk of SSI after elective colorectal surgery. Providing adequate aerobic and anaerobic coverage with OAB may confer better protection against SSI.

The role of preoperative mechanical bowel preparation and oral antibiotics in prevention of anastomotic leakage following restorative resection for primary rectal cancer - a systematic review and meta-analysis.

Anastomotic leakage after colorectal cancer resection is a feared postoperative complication seen among up till 10-20% of patients, with a higher risk following rectal resection than colon resection. Recent studies suggest that the combined use of preoperative mechanical bowel preparation and oral antibiotics may have a preventive effect on anastomotic leakage. This systematic review aims to explore the association between preoperative mechanical bowel preparation combined with oral antibiotics and the risk of anastomotic leakage following restorative resection for primary rectal cancer. Three databases were systematically searched in February 2022. Studies reporting anastomotic leakage rate in patients, who received mechanical bowel preparation and oral antibiotics before elective restorative resection for primary rectal cancer, were included. A meta-analysis was conducted based on the risk ratios of anastomotic leakage. Among 839 studies, 5 studies met the eligibility criteria. The median number of patients were 6111 (80-29,739). The combination of preoperative mechanical bowel preparation and oral antibiotics was associated with a decreased risk of anastomotic leakage (risk ratio = 0.52 (95% confidence interval 0.39-0.69), p-value < 0.001). Limitations included a low number of studies, small sample sizes and the studies being rather heterogenous. This systematic review and meta-analysis found that the use of mechanical bowel preparation and oral antibiotics is associated with a decreased risk of anastomotic leakage among patients undergoing restorative resection for primary rectal cancer. The limitations of the review should be taken into consideration when interpreting the results.

Preoperative Elective Bowel Preparation In Children With Polyethylene Glycol Versus Polyethylene Glycol and Mannitol - A Comparative Study

Background: Oral mechanical bowel preparation is a routine practice prior to colorectal surgery in many centers. Virtually all colorectal surgeons consider a mechanically cleansed and empty bowel as one of the prerequisites for a safe colonic resection and anastomosis. Various agents had been used in different centers in mechanical bowel preparation. Methods: A comparative prospective interventional analysis of preoperative elective bowel preparation in children with polyethylene glycol versus polyethylene glycol and mannitol was conducted on 60 children underwent elective GIT surgery between July 2014 and June 2016. The patients were allocated into 2 groups by simple random sampling, 30 in each group. Children of 6 months to 14 years were selected as study population. In group I, PEG was given per orally or through nasogastric tube at the rate of 1.5 gm powder/kg/dose, in group II, PEG &amp; Mannitol were given orally or via nasogastric tube. PEG was administered as same dose of group I and mannitol 20% at a dose of 10 ml/kg/dose. All patients received prophylactic intravenous antibiotics (ceftriaxone + metronidazole) preoperatively as well as in postoperative period. All children were investigated preoperatively and post operative follow up was recorded. Structured questionnaire was used to collect information regarding preoperative status and post operative follow up. Statistical assessments were done by SPSS version 21. An Ethical clearance had been sought. Results: Sixty children underwent mechanical bowel preparation prior to GIT surgery. 30 with PEG (group I) and 30 with PEG and Mannitol (group II). Our outcome variables were wound infection, anastomotic leakage, and Electrolyte balance. Demographic pattern also evaluated. The age range of both groups was 6-68 months, p value 0.987. In both group male and female were same in number, 16 male and 14 female each in both groups. Wound infection occurred 3 cases (10%) in PEG group and 2 cases in PEG and Mannitol group, p value 0.64. No anastomotic leakage in PEG and Mannitol group and only 1 leakage in PEG group. No Electrolyte imbalance was found in both groups. No mortality was recorded in this study. Conclusions: No significant difference was found between the two study groups in respect of wound infection, anastomotic leakage and electrolyte balance. Ingestion of two drugs did not have any better outcome. So, mannitol can be omitted in MBP in children. J Dhaka Med Coll. 2022; 31(1) : 29-36