Elective intestinal operations in infants and children without mechanical bowel preparation: a pilot study.
OBJECTIVE
Preoperative mechanical bowel preparation (MBP) for elective intestinal operations has been a long accepted practice. However, MBP is often unpleasant and time-consuming for patients, and clinical trials in adults have not shown improved outcomes. We conducted this pilot study to test whether omitting MBP before elective intestinal operations in infants and children would increase the risk of infectious or anastomotic complications.


METHODS
Retrospective review was performed of 143 patients who had an elective colon or distal small bowel procedure performed at our children's hospital between 1990 and 2003.


RESULTS
Thirty-three patients (No PREP) were managed by a single surgeon who routinely omitted MBP, whereas another 110 patients (PREP) were prepared with enemas, laxatives, or both. Both groups received 24 hours of preoperative dietary restriction to clear liquids and perioperative parenteral antibiotics. The No PREP group had one anastomotic leak and no wound infections, whereas the PREP group had 2 anastomotic leaks and 1 wound infection (P = .58). These results occurred despite greater duration of antibiotic therapy and incidence of delayed wound closures in the PREP group.


CONCLUSIONS
The results of this pilot study suggest that omitting MBP before elective intestinal operations in infants and children carries no increased risk of infectious or anastomotic complications. Eliminating MBP may reduce health care costs and inconvenience to patients. These findings warrant a large, prospective, randomized clinical trial to validate our findings and to investigate further the necessity of MBP in the pediatric population.
Department of Surgery, Vanderbilt Children's Hospital, Vanderbilt University Medical Center, Nashville, TN 37203, USA.
Charles M
CM
Leys
Mary T
MT
Austin
Joshua B
JB
Pietsch
Harold N
HN
Lovvorn
John B
JB
Pietsch
D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D002648:Child; D002675:Child, Preschool; D013505:Digestive System Surgical Procedures / Q000379:methods*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007223:Infant; D007410:Intestinal Diseases / Q000601:surgery*; D008297:Male; D010865:Pilot Projects; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D013530:Surgical Wound Infection / Q000517:prevention & control*
D000900:Anti-Bacterial Agents