[Colorectal preparation for excision surgery. Development after 4 randomized multicenter studies]

Area of Science:

• Colorectal Surgery
• Surgical Preparation
• Infectious Disease Prevention

Background:

• Postoperative infections are a significant concern following colectomy.
• Optimizing bowel preparation is crucial for reducing surgical site infections.
• Previous studies have explored various preparation methods with mixed results.

Purpose of the Study:

• To compare the efficacy and tolerability of different bowel preparation methods for elective colectomy.
• To determine the optimal duration of preoperative antibiotic therapy.
• To reduce the rate of postoperative infections in colectomy patients.

Main Methods:

• Four successive randomized multidepartmental studies involving 1,265 patients undergoing colectomy.
• Comparison of conventional preparation (CP) with total digestive irrigation (TDI) and Sennosides.
• Evaluation of different preoperative antibiotic regimens (Neomycin, Tetracyclin, Metronidazole, Cefotaxime) and durations.

Main Results:

• Total digestive irrigation (TDI) showed high intolerance (50%) and increased fistulae compared to CP.
• Sennosides were better tolerated and significantly more effective than CP.
• No significant difference in infection rates between three-day and 24-hour antibiotic therapy.

Conclusions:

• Sennosides represent a superior bowel preparation method for colectomy compared to CP and Mannitol.
• A 24-hour antibiotic regimen is as effective as a three-day regimen in preventing postoperative infections.
• Optimized bowel preparation and antibiotic therapy can reduce postoperative complications.