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Preparación intestinal mecánica y oral frente a la ausencia de preparación intestinal para colectomía electiva
Laura Koskenvuo1, Taru Lehtonen1, Selja Koskensalo1
1Department of Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Lancet (London, England)
|August 13, 2019
Resumen
La preparación intestinal mecánica y oral (MOABP, por sus siglas en inglés) no reduce las infecciones del sitio quirúrgico (SSI, por sus siglas en inglés) ni la morbilidad en la cirugía de colon en comparación con la no preparación intestinal (NBP, por sus siglas en inglés). Las recomendaciones actuales para el MOABP en colectomías deben ser reconsideradas en base a estos hallazgos.
Área de la Ciencia:
- Cirugía colorrectal
- Prevención quirúrgica de las infecciones
- Cirugía gastrointestinal
Sus antecedentes:
- Se recomienda la preparación intestinal mecánica y oral con antibióticos (MOABP) para la cirugía de colon para disminuir las infecciones en el sitio quirúrgico (SSI) y la morbilidad.
- La evidencia que respalda el MOABP de rutina se basa en estudios anteriores, lo que provocó una investigación en un ensayo aleatorizado prospectivo.
Objetivo del estudio:
- Evaluar la eficacia de la MOABP en comparación con la no preparación intestinal (NBP) en la reducción de las ISS y la morbilidad general en pacientes sometidos a resección electiva del colon.
- Desafiar las recomendaciones existentes para la MOABP de rutina en cirugía de colon.
Principales métodos:
- Se realizó un ensayo multicéntrico, paralelo, aleatorizado y controlado en el que participaron pacientes sometidos a resección de colon.
- Los pacientes fueron asignados al azar (1:1) para recibir MOABP o NBP, con asignación enmascarada para todo el personal involucrado.
- El resultado primario fue SSI dentro de los 30 días, analizado utilizando un enfoque modificado de intención de tratar.
Principales resultados:
- Un total de 396 pacientes fueron incluidos en el análisis modificado de intención de tratar (196 en MOABP, 200 en NBP).
- Las ISS ocurrieron en el 7% del grupo MOABP frente al 11% del grupo NBP (p=0,17), no mostrando diferencias estadísticamente significativas.
- Las tasas de dehiscencia anastomática y reoperaciones fueron similares entre los dos grupos; dos muertes ocurrieron en el grupo NBP, ninguna en el grupo MOABP.
Conclusiones:
- La preparación intestinal mecánica y oral (MOABP, por sus siglas en inglés) no demostró una reducción significativa en las infecciones del sitio quirúrgico (SSI, por sus siglas en inglés) o en la morbilidad general en comparación con la no preparación intestinal (NBP, por sus siglas en inglés) en cirugía de colon.
- Los hallazgos sugieren que las recomendaciones actuales para la MOABP de rutina en colectomías deben ser reevaluadas.
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