Role of Mechanical Bowel Preparation and Perioperative Antibiotics in Pediatric Pull-Through Procedures
Kyle L Carpenter1, Francine D Breckler2, Brian W Gray3
1Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
Insights
Mechanical bowel preparation did not impact overall complication rates in pediatric colorectal surgery. However, it increased wound infections in perineal anoplasty cases. Postoperative antibiotic duration showed no significant effect on complications.
Area of Science:
- Pediatric surgery
- Colorectal surgery
- Surgical complications
Background:
- No clear guidelines exist for mechanical bowel preparation (MBP) and postoperative antibiotics in pediatric elective colorectal pull-through surgery.
- This study addresses the impact of MBP and antibiotic duration on complication rates.
Purpose of the Study:
- To determine if preoperative mechanical bowel preparation administration impacts complication rates.
- To assess if the duration of postoperative antibiotics affects complication rates after pediatric elective pull-through surgery.
Main Methods:
- Retrospective review of 180 pediatric patients (<18 years) undergoing pull-through procedures (2011-2017).
- Data collected on diagnosis, procedure, MBP, and perioperative intravenous (IV) antibiotic duration.
- Outcomes analyzed included surgical site infections and anastomotic complications.
Main Results:
- Overall complication rate was 12.2% with no significant difference between patients receiving MBP versus those who did not (14.1% vs. 10.5%).
- MBP was associated with higher wound infection rates in the perineal anoplasty subgroup (33.3% vs. 3.3%).
- Antibiotic duration of ≤24 hours showed similar complication rates (13.3%) compared to >24 hours (11.6%).
Conclusions:
- MBP did not influence overall complication rates in pull-through procedures but increased wound infections in perineal anoplasty.
- Postoperative IV antibiotic duration was not significantly associated with wound and anastomotic complication rates.
Background:
There are no clear guidelines for the use of mechanical bowel preparation and postoperative antibiotics in children undergoing elective colorectal pull-through surgery. The objective of this study was to determine whether preoperative bowel preparation administration or duration of postoperative antibiotics impacted the rate of complications after elective pediatric pull-through surgery.
Materials And Methods:
Patients aged <18 y who underwent a pull-through procedure between 2011 and 2017 were retrospectively identified. Patient data included diagnosis, procedure, administration of mechanical bowel preparation, and duration of perioperative intravenous (IV) antibiotics. Outcomes of interest included surgical site infections and anastomotic complications.
Results:
A total of 180 patients met inclusion criteria, of which 47.2% received mechanical bowel preparation. The combined rate of infectious and anastomotic complications was 12.2%. There was no significant difference in combined complication rate among those receiving bowel preparation compared with those who did not (14.1% versus 10.5%, P = 0.46). Administration of bowel preparation in the perineal anoplasty subgroup was associated with higher rates of wound infection (33.3% versus 3.3%, P = 0.05). One hundred five patients (58.3%) received perioperative IV antibiotics for ≤24 h. This group had similar rates of complications (13.3%) compared with those receiving IV antibiotics for longer than 24 h (11.6%, P = 0.74).
Conclusions:
Although mechanical bowel preparation did not affect the overall complication rate for pull-through procedures, it was associated with more wound infections in those undergoing perineal anoplasty. Duration of postoperative IV antibiotics was not significantly associated with the rate of wound and anastomotic complications.
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