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The impact of mechanical bowel preparation in elective colorectal surgery: a propensity score matching analysis
Young Wan Kim1, Eun Hee Choi2, Ik Yong Kim3
1Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.
Purpose:
To evaluate the influence of preoperative mechanical bowel preparation (MBP) based on the occurrence of anastomosis leakage, surgical site infection (SSI), and severity of surgical complication when performing elective colorectal surgery.
Materials And Methods:
MBP and non-MBP patients were matched using propensity score. The outcomes were evaluated according to tumor location such as right- (n=84) and left-sided colon (n=50) and rectum (n=100). In the non-MBP group, patients with right-sided colon cancer did not receive any preparation, and patients with both left-sided colon and rectal cancers were given one rectal enema before surgery.
Results:
In the right-sided colon surgery, there was no anastomosis leakage. SSI occurred in 2 (4.8%) and 4 patients (9.5%) in the non-MBP and MBP groups, respectively. In the left-sided colon cancer surgery, there was one anastomosis leakage (4.0%) in each group. SSI occurred in none in the rectal enema group and in 2 patients (8.0%) in the MBP group. In the rectal cancer surgery, there were 5 anastomosis leakages (10.0%) in the rectal enema group and 2 (4.0%) in the MBP group. SSI occurred in 3 patients (6.0%) in each groups. Severe surgical complications (Grade III, IV, or V) based on Dindo-Clavien classification, occurred in 7 patients (14.0%) in the rectal enema group and 1 patient (2.0%) in the MBP group (p=0.03).
Conclusion:
Right- and left-sided colon cancer surgery can be performed safely without MBP. In rectal cancer surgery, rectal enema only before surgery seems to be dangerous because of the higher rate of severe postoperative complications.
Insights
Mechanical bowel preparation (MBP) is not necessary for right- or left-sided colon cancer surgery. However, for rectal cancer surgery, MBP is associated with fewer severe complications compared to a simple rectal enema.
Area of Science:
- Colorectal Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Preoperative mechanical bowel preparation (MBP) is a common practice in colorectal surgery, but its necessity and impact on outcomes are debated.
- The role of MBP may vary depending on tumor location and surgical approach.
Purpose of the Study:
- To evaluate the influence of preoperative mechanical bowel preparation (MBP) on anastomosis leakage, surgical site infection (SSI), and surgical complication severity in elective colorectal surgery.
- To compare outcomes based on tumor location: right-sided colon, left-sided colon, and rectum.
Main Methods:
- Propensity score matching was used to compare MBP and non-MBP patient groups.
- Outcomes were analyzed for right-sided colon (n=84), left-sided colon (n=50), and rectal (n=100) cancer surgeries.
- Non-MBP for right-sided colon cancer involved no preparation; for left-sided colon and rectal cancers, it involved a single rectal enema.
Main Results:
- No anastomosis leakage occurred in right-sided colon surgery. SSI rates were similar between MBP and non-MBP groups.
- In left-sided colon cancer surgery, anastomosis leakage rates were low and similar in both groups; SSI was absent in the enema group and low in the MBP group.
- Rectal cancer surgery showed higher anastomosis leakage and similar SSI rates with enema compared to MBP. Severe complications (Dindo-Clavien Grade III-V) were significantly higher in the enema group (14.0%) versus MBP group (2.0%) (p=0.03).
Conclusions:
- Elective surgery for right- and left-sided colon cancer can be safely performed without mechanical bowel preparation.
- In rectal cancer surgery, using only a rectal enema before surgery is associated with a higher rate of severe postoperative complications compared to MBP.
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