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Mechanical bowel preparation for children undergoing elective colorectal surgery

Jennifer H Aldrink1, Cindy McManaway, Wei Wang

  • 1*Division of Pediatric Surgery, Department of Surgery, Ohio State University College of Medicine †Department of Biostatistics, Nationwide Children's Hospital, Columbus, OH.

Journal of Pediatric Gastroenterology and Nutrition
|April 1, 2015
PubMed
Abstract

Insights

Mechanical bowel preparation (MBP) in pediatric colorectal surgery does not increase infectious complications. This pilot study found no significant difference in anastomotic leaks or infections between patients who received MBP and those who did not.

Area of Science:

  • Pediatric Surgery
  • Colorectal Surgery
  • Surgical Complications

Background:

  • Adult literature suggests mechanical bowel preparation (MBP) is unnecessary for elective colorectal surgery.
  • Prospective data on MBP's utility in pediatric colorectal surgery is limited.
  • Infectious complications are a concern following colorectal procedures.

Purpose of the Study:

  • To compare infectious complications, including anastomotic leak, intraabdominal abscess, and wound infection.
  • To evaluate the necessity of MBP in pediatric patients undergoing elective colorectal surgery.
  • To provide data for future clinical practice guidelines in pediatric colorectal surgery.

Main Methods:

  • A randomized pilot study comparing MBP with polyethylene glycol versus no MBP.
  • Inclusion of patients aged 0 to 21 years undergoing elective colorectal surgery.
  • Randomization within four age strata and statistical analysis using chi-squared or Fisher exact test for categorical data and t test or Wilcoxon 2-sample test for continuous data.

Main Results:

  • Forty-four pediatric patients were enrolled; 24 received MBP and 20 did not.
  • Overall rates: 5% anastomotic leak, 9% intraabdominal infection, 16% wound infection.
  • No significant difference in anastomotic leak, intraabdominal abscess, or wound infection rates between the MBP and no-MBP groups.

Conclusions:

  • MBP does not appear to affect the incidence of infectious complications in children undergoing elective colorectal surgery.
  • This single-institution pilot study suggests MBP may not be necessary in this population.
  • A larger, multi-institutional study is required to confirm these findings and guide clinical practice.

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