The influence of mechanical bowel preparation in elective colorectal surgery for diverticulitis.
BACKGROUND
Mechanical bowel preparation (MBP) has been shown to have no influence on the incidence of anastomotic leakage in overall colorectal surgery. The role of MBP in elective surgery in combination with an inflammatory component such as diverticulitis is yet unclear. This study evaluates the effects of MBP on anastomotic leakage and other septic complications in 190 patients who underwent elective surgery for colonic diverticulitis.


METHODS
A subgroup analysis was performed in a prior multicenter (13 hospitals) randomized trial comparing clinical outcome of MBP versus no MBP in elective colorectal surgery. Primary endpoint was the occurrence of anastomotic leakage in patients operated on for diverticulitis, and secondary endpoints were septic complications and mortality.


RESULTS
Out of a total of 1,354 patients, 190 underwent elective colorectal surgery (resection with primary anastomosis) for (recurrent or stenotic) diverticulitis. One hundred and three patients underwent MBP prior to surgery and 87 did not. Anastomotic leakage occurred in 7.8 % of patients treated with MBP and in 5.7 % of patients not treated with MBP (p = 0.79). There were no significant differences between the groups in septic complications and mortality.


CONCLUSIONS
Mechanical bowel preparation has no influence on the incidence of anastomotic leakage, or other septic complications, and may be safely omitted in case of elective colorectal surgery for diverticulitis.
Department of Surgery, Ikazia Hospital, Montessoriweg 1, 3083 AN, Rotterdam, The Netherlands. h.vantsant@erasmusmc.nl
H P
HP
Van't Sant
J C
JC
Slieker
W C J
WC
Hop
W F
WF
Weidema
J F
JF
Lange
J
J
Vermeulen
C M E
CM
Contant
D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000453:epidemiology; D002400:Cathartics / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D013505:Digestive System Surgical Procedures; D004238:Diverticulitis / Q000601:surgery*; D017558:Elective Surgical Procedures; D005242:Fecal Incontinence / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011300:Preoperative Care / Q000379:methods*; D012044:Regression Analysis; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology; D018709:Statistics, Nonparametric; D013530:Surgical Wound Infection / Q000453:epidemiology; D016896:Treatment Outcome
D002400:Cathartics