Is There a Role for Mechanical and Oral Antibiotic Bowel Preparation for Patients Undergoing Minimally Invasive...

Area of Science:

• Colorectal Surgery
• Surgical Infection Prevention
• Minimally Invasive Procedures

Background:

• Existing meta-analyses often combine open and minimally invasive colorectal surgery, potentially skewing results.
• The efficacy of mechanical bowel preparation (MBP) and oral antibiotic prophylaxis (OA) specifically for minimally invasive elective colorectal surgery requires focused assessment.
• Surgical site infection (SSI) and other complications remain significant concerns in colorectal procedures.

Approach:

• A systematic literature search was conducted across major databases (PubMed, Science Direct, Google Scholar, Cochrane Library) from 2000 to May 2022.
• Included were comparative randomized and non-randomized studies evaluating MBP, OA, or their combination.
• Methodological quality was assessed using Rob v2 and Robins-I tools.

Key Points:

• Eighteen studies (7 RCTs, 11 cohort studies) were included in the meta-analysis.
• The combination of MBP + OA demonstrated a significant reduction in SSI, anastomotic leak (AL), and overall morbidity compared to no preparation, MBP alone, or OA alone.
• This combination approach proved superior in the context of minimally invasive elective colorectal surgery.

Conclusions:

• The addition of oral antibiotic prophylaxis (OA) to mechanical bowel preparation (MBP) positively impacts outcomes in minimally invasive colorectal surgery.
• Combining MBP and OA is recommended to decrease SSI, AL, and overall morbidity in patients undergoing these specific procedures.
• This evidence supports the routine use of combined MBP and OA for selected patients undergoing minimally invasive elective colorectal surgery.