Zorbas KA, Yu D, Choudhry A, Ross HM, Philp M. Preoperative bowel preparation does not favor the management of colorectal anastomotic leak. World J Gastrointest Surg 2019; 11(4): 218-228 [PMID: 31123559 DOI: 10.4240/wjgs.v11.i4.218]
Corresponding Author of This Article
Konstantinos A Zorbas, MD, Doctor, Department of Surgery,Bronx Care Health System (Bronx Lebanon Hospital), NY 10457, United States. zorbasko@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
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/
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
ARTICLE HIGHLIGHTS
Research 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.
Research motivation
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.
Research objectives
We aimed to determine the association between preoperative bowel preparation and postoperative anastomotic leak management (surgical vs non-surgical). We hypothesized that patients experiencing anastomotic leaks, following preoperative bowel preparation, would less likely require reoperation for the leak management.
Research methods
We performed a retrospective analysis of patients who had a colorectal resection with anastomosis creation and subsequently developed anastomotic leak. 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.
Research results
There was no statistically significant difference between the three groups of bowel preparation in terms of reoperation for anastomotic leak management.
Research conclusions
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.
Research perspectives
With the findings of this study we think that the clinical decision on the further treatment of anastomotic leak should not be influenced by the patient’s preoperative bowel preparation.
