Retrospective Cohort Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2019; 11(4): 218-228
Published online Apr 27, 2019. doi: 10.4240/wjgs.v11.i4.218
Preoperative bowel preparation does not favor the management of colorectal anastomotic leak
Konstantinos A Zorbas, Daohai Yu, Aruj Choudhry, Howard M Ross, Matthew Philp
Konstantinos A Zorbas, Department of Surgery, BronxCare Health System, NY 10457, United States
Konstantinos A Zorbas, Aruj Choudhry, Howard M Ross, Matthew Philp, Department of Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, United States
Daohai Yu, Department of Clinical Sciences, Lewis Katz School of Medicine, Temple University, PA 19140, United States
Author contributions: Zorbas KA contributed to conception and design of the work; acquisition, statistical analysis, and interpretation of data for the work, and drafting the work, table and figure construction; Yu D contributed to statistical analysis and interpretation of data for the work; and substantial contributions to the analysis and interpretation of data for the work; Ross HM contributed to substantial contributions to the interpretation of data for the work; Philp M contributed to conception and design of the work; acquisition, and interpretation of data for the work, and drafting the work and revising it critically for important intellectual content; Yu D, Choudhry A and Philp M contributed to revising it critically for important intellectual content; all authors final approval of the version to be published and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Institutional review board statement: The NSQIP data base is a de-identified patient database and consequently our study was exempt from institutional review board (IRB) approval.
Conflict-of-interest statement: We have no conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Konstantinos A Zorbas, MD, Doctor, Department of Surgery,Bronx Care Health System (Bronx Lebanon Hospital), NY 10457, United States. zorbasko@gmail.com
Telephone: +1-267-2942932 Fax: +1-215-7071241
Received: March 4, 2019
Peer-review started: March 4, 2019
First decision: March 19, 2019
Revised: March 23, 2019
Accepted: April 9, 2019
Article in press: April 9, 2019
Published online: April 27, 2019
Abstract
BACKGROUND

Controversy exists regarding the impact of preoperative bowel preparation on patients undergoing colorectal surgery. This is due to previous research studies, which fail to demonstrate protective effects of mechanical bowel preparation against postoperative complications. However, in recent studies, combination therapy with oral antibiotics (OAB) and mechanical bowel preparation seems to be beneficial for patients undergoing an elective colorectal operation.

AIM

To determine the association between preoperative bowel preparation and postoperative anastomotic leak management (surgical vs non-surgical).

METHODS

Patients with anastomotic leak after colorectal surgery were identified from the 2013 and 2014 Colectomy Targeted American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database and were employed for analysis. Every patient was assigned to one of three following groups based on the type of preoperative bowel preparation: first group-mechanical bowel preparation in combination with OAB, second group-mechanical bowel preparation alone, and third group-no preparation.

RESULTS

A total of 652 patients had anastomotic leak after a colectomy from January 1, 2013 through December 31, 2014. Baseline characteristics were assessed and found that there were no statistically significant differences between the three groups in terms of age, gender, American Society of Anesthesiologists score, and other preoperative characteristics. A χ2 test of homogeneity was conducted and there was no statistically/clinically significant difference between the three categories of bowel preparation in terms of reoperation.

CONCLUSION

The implementation of mechanical bowel preparation and antibiotic use in patients who are going to undergo a colon resection does not influence the treatment of any possible anastomotic leakage.

Keywords: Preoperative bowel preparation, Preoperative mechanical bowel preparation, Preoperative oral antibiotics, Colorectal anastomotic leak, Anastomotic leak, Bowel preparation, Colorectal surgery, National Surgical Quality Improvement Program

Core tip: Anastomotic leak after colon resection contributes significantly to postoperative morbidity and mortality. Surgeons are constantly seeking ways to decrease the rate of the anastomotic leak by optimizing the patient before the operation. Currently the preoperative bowel preparation constitutes a significant field of debate. We aimed to determine the association between preoperative bowel preparation and postoperative anastomotic leak management, surgical versus non-surgical. We found that the implementation of mechanical bowel preparation and antibiotic use in patients who are going to undergo a colon resection does not influence the treatment of any possible anastomotic leakage.