Optimal preoperative bowel preparation for intracorporeal anastomosis in laparoscopic colectomy

There are concerns regarding postoperative infections following laparoscopic colectomy with intracorporeal anastomosis. Thus, in this study, we aimed to determine the optimal preoperative bowel preparation to reduce postoperative infectious complications in patients undergoing laparoscopic colectomy with intracorporeal anastomosis.

This secondary analysis of the ICAN study-a multicenter, retrospective cohort study involving 46 institutions affiliated with the Japan Society of Laparoscopic Colorectal Surgery-included 615 patients with colon adenocarcinoma undergoing laparoscopic colectomy with intracorporeal anastomosis between January 2020 and December 2021. Patients were analyzed after applying eligibility criteria and propensity score matching based on age ≥ 65 years, sex, body mass index ≥ 30, American Society of Anesthesiologists Physical Status, diabetes, and the number of intracorporeal anastomosis cases previously performed at the institution. Among them, 312 received combined oral antibiotics and mechanical bowel preparation, whereas 156 received other preparations (mechanical preparation alone, oral antibiotics alone, and no preparation). The primary outcome was surgical wound infection incidence (Clavien-Dindo grade ≥ II) at initial discharge. Secondary outcomes included intraperitoneal infections, anastomotic leakage, ileus, and postoperative hospital stay.

Surgical wound infection (1/312 [0.3%] vs. 6/156 [3.8%], P = 0.006, odds ratio: 0.083, 95% confidence interval: 0.01-0.686) and intraperitoneal infection incidences (1/312 [0.3%] vs. 4/156 [2.6%], P = 0.044, odds ratio: 0.125, 95% confidence interval: 0.014-1.109) were lower in the combined preparation group, whereas anastomotic leakage or paralytic ileus did not significantly differ. The median postoperative hospital stay was significantly shorter in the combined group (8 days [interquartile range, 7-10]) than in the other group (9 days [interquartile range, 7-12]; P < 0.001).

Combined oral antibiotics and mechanical bowel preparation yields favorable outcomes, including fewer infectious complications and shorter hospital stays, in laparoscopic colectomy with intracorporeal anastomosis.