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Published on: August 1, 2019
Multicentre randomized clinical trial of mechanical bowel preparation in elective colonic resection
B Jung1, L Påhlman, P-O Nyström
1University of Umeå, Department of Surgery, Visby Hospital, Visby, Sweden. barbel.jung@hsf.gotland.se
Background:
Recent studies have suggested that MBP does not lower the risk of postoperative septic complications after elective colorectal surgery. This randomized clinical trial assessed whether preoperative MBP is beneficial in elective colonic surgery.
Methods:
A total of 1505 patients, aged 18-85 years with American Society of Anesthesiologists grades I-III, were randomized to MBP or no MBP before open elective surgery for cancer, adenoma or diverticular disease of the colon. Primary endpoints were cardiovascular, general infectious and surgical-site complications within 30 days, and secondary endpoints were death and reoperations within 30 days.
Results:
A total of 1343 patients were evaluated, 686 randomized to MBP and 657 to no MBP. There were no significant differences in overall complications between the two groups: cardiovascular complications occurred in 5.1 and 4.6 per cent respectively, general infectious complications in 7.9 and 6.8 per cent, and surgical-site complications in 15.1 and 16.1 per cent. At least one complication was recorded in 24.5 per cent of patients who had MBP and 23.7 per cent who did not.
Conclusion:
MBP does not lower the complication rate and can be omitted before elective colonic resection.
Registration Number:
ISRCTN28535118 (http://www.controlled-trials.com).
Insights
Preoperative mechanical bowel preparation (MBP) does not reduce complications in elective colonic surgery. This study found no significant difference in postoperative complications, suggesting MBP can be omitted before colonic resection.
Area of Science:
- Colorectal Surgery
- Surgical Complications
- Clinical Trials
Background:
- Recent studies question the efficacy of mechanical bowel preparation (MBP) in reducing postoperative septic complications after elective colorectal surgery.
- This randomized clinical trial investigated the benefit of preoperative MBP in elective colonic surgery.
Purpose of the Study:
- To assess the effectiveness of preoperative mechanical bowel preparation (MBP) in reducing complications following elective colonic surgery.
Main Methods:
- 1505 patients (ASA grades I-III, aged 18-85) were randomized to receive MBP or no MBP before open elective colonic surgery.
- Outcomes included cardiovascular, general infectious, and surgical-site complications within 30 days, as well as death and reoperations.
Main Results:
- No significant differences in overall complications were observed between the MBP and no MBP groups (24.5% vs. 23.7%).
- Specific complication rates (cardiovascular, infectious, surgical-site) did not differ significantly between the groups.
Conclusions:
- Preoperative mechanical bowel preparation (MBP) does not lower the complication rate in elective colonic resection.
- MBP can be omitted before elective colonic resection without impacting patient outcomes.
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