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Technical Detail for Robot Assisted Pancreaticoduodenectomy
Published on: September 28, 2019
Preoperative mechanical bowel preparation does not offer a benefit for patients who undergo pancreaticoduodenectomy
Harish Lavu1, Eugene P Kennedy, Ross Mazo
1Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA. harish.lavu@jefferson.edu
Background:
Mechanical bowel preparations (MBPs) are commonly administered preoperatively to patients who undergo pancreaticoduodenectomy (PD); however, their effectiveness over a clear liquid diet (CLD) preparation remains unclear. The aim of this study was to determine whether MBP offers an advantage to patients who undergo PD.
Methods:
In this retrospective review, we analyzed the clinical data from 100 consecutive PDs performed on patients who received preoperative MBP from March 2006 to April 2007, and we compared them with 100 consecutive patients who received a preoperative CLD from May 2007 to March 2008.
Results:
No differences were observed between the MBP and CLD groups in the rates of pancreatic fistula (13% vs 14%; P = 1.0), intra-abdominal abscess (11% vs 13%; P = .83), or wound infection (9% vs 8%; P = 1.0). Trends toward increased urinary tract infections (13% vs 5%; P < .08) and Clostridium difficile infections were found in the MBP group (6% vs 1%; P = .12). The median duration of postoperative hospital stay was 7 days in each group, and the 12-month survival rates were equivalent (74% vs 75%; P = 1.0).
Conclusion:
There is no clinical benefit to the administration of a preoperative MBP for patients undergoing PD.
Insights
Mechanical bowel preparations (MBPs) do not offer benefits over clear liquid diets (CLDs) for patients undergoing pancreaticoduodenectomy (PD). This study found no significant differences in complications or outcomes between MBP and CLD groups.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Clinical Nutrition
Background:
- Mechanical bowel preparations (MBPs) are standard preoperative care for pancreaticoduodenectomy (PD).
- The comparative effectiveness of MBPs versus clear liquid diet (CLD) preparation is not well-established.
- This study addresses the clinical utility of MBPs in PD patients.
Purpose of the Study:
- To evaluate the clinical benefit of preoperative mechanical bowel preparation (MBP) in patients undergoing pancreaticoduodenectomy (PD).
- To compare surgical outcomes and complications between patients receiving MBP and those on a clear liquid diet (CLD).
Main Methods:
- Retrospective analysis of 100 consecutive PD patients who received MBP.
- Comparison with 100 consecutive PD patients who received a preoperative CLD.
- Data analysis focused on postoperative complications, hospital stay, and survival rates.
Main Results:
- No significant differences in pancreatic fistula, intra-abdominal abscess, or wound infection rates between MBP and CLD groups.
- A trend towards increased urinary tract and Clostridium difficile infections was observed in the MBP group.
- Median postoperative hospital stay and 12-month survival rates were equivalent for both preparation methods.
Conclusions:
- Preoperative mechanical bowel preparation (MBP) provides no demonstrable clinical advantage for patients undergoing pancreaticoduodenectomy (PD).
- Clear liquid diet (CLD) preparation is a viable alternative to MBP for PD patients.
- Current evidence does not support routine MBP for PD procedures.