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Efficacy of a Shortened Oral Antibiotic Bowel Decontamination in Minimally Invasive Surgery for Diverticular Disease
Josefine Schardey1, Thomas von Ahnen2, Alexander Crispin3
1Department of General, Visceral and Transplantation Surgery, LMU University Hospital, LMU Munich, Munich, Germany.
Introduction:
Infectious complications, such as anastomotic leakage (AL) and surgical site infections (SSIs), remain a significant challenge in colorectal surgery. Consequently, there is growing interest in oral antibiotic bowel decontamination with nonabsorbable antibiotics (selective digestive decontamination or SDD), which can reduce perioperative complications while also minimizing antibiotic use. This study aimed to determine whether a 3-day SDD regimen is as effective as a 7-day regimen in preventing postoperative complications in laparoscopic diverticular surgery.
Methods:
A bicenter data analysis of prospectively and retrospectively collected patient data was performed. A 3-day versus 7-day perioperative use of an SDD-based regimen (polymyxin B, gentamicin, vancomycin, and amphotericin B) in patients undergoing minimally invasive surgery for diverticular disease was compared using noninferiority analysis.
Results:
A total of 469 patients were included in the analysis: 101 patients received a 3-day perioperative SDD regimen, while 368 patients received a 7-day regimen. Due to the use of routine clinical data, no control cohort is available. The overall complication rate was 16.5% in both groups. AL and SSI occurred in 2.0% and 6.0% of the 3-day group, and in 1.4% and 6.3% of the 7-day group, respectively, with no significant differences between the groups. However, for wound infections and overall infectious complications, the 3-day regimen can be considered noninferior to the 7-day regimen. Our data did not confirm the noninferiority of the SDD3 regimen compared to the SDD7 regimen for AL.
Discussion:
We report low rates of AL and other surgical and nonsurgical complications in minimally invasive diverticular disease surgery. The low complication rates demonstrate noninferiority regarding SSI. Our findings are consistent with recent evidence, highlighting the positive impact of perioperative SDD treatment on SSI and infectious complications.
Insights
A 3-day selective digestive decontamination (SDD) regimen is noninferior to a 7-day regimen for preventing surgical site infections in laparoscopic diverticular surgery, though not for anastomotic leakage. This finding supports shorter SDD durations for reducing complications.
Area of Science:
- Colorectal Surgery
- Surgical Infections
- Antibiotic Therapy
Background:
- Infectious complications like anastomotic leakage (AL) and surgical site infections (SSIs) are significant challenges in colorectal surgery.
- Selective digestive decontamination (SDD) using nonabsorbable antibiotics is gaining interest to reduce perioperative complications and antibiotic use.
Purpose of the Study:
- To determine if a 3-day SDD regimen is as effective as a 7-day regimen in preventing postoperative complications in laparoscopic diverticular surgery.
Main Methods:
- A bicenter data analysis compared 3-day versus 7-day perioperative SDD regimens (polymyxin B, gentamicin, vancomycin, amphotericin B) in patients undergoing minimally invasive surgery for diverticular disease.
- Noninferiority analysis was used to compare outcomes between the two groups.
Main Results:
- A total of 469 patients were analyzed (101 in the 3-day group, 368 in the 7-day group).
- Overall complication rates were 16.5% in both groups.
- While the 3-day regimen was noninferior for wound infections and overall infectious complications, it was not noninferior for anastomotic leakage (AL).
Conclusions:
- Minimally invasive surgery for diverticular disease is associated with low complication rates.
- Perioperative SDD treatment positively impacts SSIs and infectious complications.
- A 3-day SDD regimen may be a viable alternative to a 7-day regimen for preventing certain complications, but further investigation is needed for AL.
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