Luminal Peri-Anastomotic Antibacterial Washout to Prevent Colorectal Anastomotic Leakage: A Pilot Audit of Outcomes

Oral antibiotics usually given for 24 h prior to surgery have been shown to result in lower anastomotic leak rates, as a result of luminal decontamination. Delivering antibiotics into the lumen of the intestine at the time of surgery may be a simpler way to achieve this outcome.

An audit was undertaken of the first 50 consecutive patients undergoing luminal peri-anastomotic antibiotic washout performed by a single surgeon at two surgical institutions. The luminal washout initially involved metronidazole (500 mg) and gentamicin (240 mg) followed by the addition of ampicillin (1000 mg) for latter patients. The combined solution was delivered to the lumen of both sides of the colorectal anastomosis using either a soaked Raytec surgical gauze or syringe, or both. Follow up was performed for 30 days to assess for anastomotic leak, complications, clostridium difficile colitis and acute kidney injury, and at 90 days for mortality.

The 30 and 90 day mortality was zero. There were no anastomotic leaks and no cases of clostridium difficile colitis. Complications occurred in six patients, with three readmissions within 30 days. There were no cases of acute kidney injury.

Peri-anastomotic luminal washout with antibiotics is feasible and safe. It does not appear to have deleterious effects and should be compared to peri-operative oral antibiotics in larger clinical trials.