Bowel preparation is associated with spillage of bowel contents in colorectal surgery.
OBJECTIVE
Infectious complications pose a significant cause of morbidity in colon and rectal surgery. This study was designed to assess the effect of bowel preparation on spillage of bowel contents into the peritoneal cavity during colorectal surgery, and its potential effect on the rate of postoperative infectious complications.


METHODS
The quality of bowel preparation and the incidence of spillage of bowel contents were prospectively assessed in patients undergoing elective colon and rectal resection. The patients were followed for 30 days for postoperative infectious and noninfectious complications.


RESULTS
A total of 333 patients were included in this study, of which 181 did not receive mechanical bowel preparation. Intraoperative spillage of bowel contents occurred in 48 patients (14 percent), whereas in 285 patients (86 percent), spillage did not occur. There was a trend toward a higher rate of overall surgical infectious and noninfectious complications in patients who had spillage of bowel contents compared with patients without spillage; however, this difference was not statistically significant (18.7 vs. 11 percent, and 29 vs. 19 percent, respectively). Preoperative mechanical bowel preparation and colocolonic or colorectal anastomosis was associated with a higher rate of bowel contents spillage, although this difference did not reach statistical significance. Liquid colonic contents caused significantly higher rates of spillage.


CONCLUSIONS
Spillage of bowel contents into the peritoneal cavity during colon and rectal surgery may increase the rate of postoperative infectious complications. In addition, inadequate mechanical bowel preparation, leading to liquid bowel contents, increases the rate of intraoperative spillage.
Department of General Surgery A, Rambam Medical Center and the Bruce Rappoport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Ahmad
A
Mahajna
Michael
M
Krausz
Danny
D
Rosin
Moshe
M
Shabtai
Dani
D
Hershko
Amram
A
Ayalon
Oded
O
Zmora
D000038:Abscess / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D002400:Cathartics / Q000008:administration & dosage / Q000627:therapeutic use*; D003106:Colon / Q000601:surgery*; D017558:Elective Surgical Procedures; D005243:Feces; D005260:Female; D005500:Follow-Up Studies; D005766:Gastrointestinal Contents / Q000382:microbiology*; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D010529:Peritoneal Cavity / Q000382:microbiology*; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000627:therapeutic use; D011183:Postoperative Complications; D011300:Preoperative Care; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000209:etiology*
D002400:Cathartics; D011092:Polyethylene Glycols