Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
Updates in Surgery
Erschienen in: Updates in Surgery 2/2019

21.03.2018 | Review Article

Effectiveness of mechanical bowel preparation versus no preparation on anastomotic leakage in colorectal surgery: a systematic review and meta-analysis

verfasst von: Jobbe P. L. Leenen, Judith E. K. R. Hentzen, Henrietta D. L. Ockhuijsen

Erschienen in: Updates in Surgery | Ausgabe 2/2019

Einloggen, um Zugang zu erhalten

Abstract

It has been a standard practice to perform mechanical bowel preparation (MBP) prior to colorectal surgery to reduce the risk of colorectal anastomotic leakages (CAL). The latest Cochrane systematic review suggests there is no benefit for MBP in terms of decreasing CAL, but new studies have been published. The aim of this systematic review and meta-analysis is to update current evidence for the effectiveness of preoperative MBP on CAL in patients undergoing colorectal surgery. Consequently, PubMed, MEDLINE, Embase, CENTRAL and CINAHL were searched from 2010 to March 2017 for randomised controlled trials (RCT) that compared the effects of MBP in colorectal surgery on anastomotic leakages. The outcome CAL was expressed in odds ratios and analysed with a fixed-effects analysis in a meta-analysis. Quality assessment was performed by the cochrane risk of bias tool and grades of recommendation, assessment, development and evaluation (GRADE) methodology. Eight studies (1065 patients) were included. The pooled odds ratio showed no significant difference of MBP in colorectal surgery on CAL (odds ratio (OR) = 1.15, 95% CI = 0.68–1.94). According to GRADE methodology, the quality of the evidence was low. To conclude, MBP for colorectal surgery does not lower the risk of CAL. These results should, however, be interpreted with caution due to the small sample sizes and poor quality. Moreover, the usefulness of MBP in rectal surgery is not clear due to the lack of stratification in many studies. Future research should focus on high-quality, adequately powered RCTs in elective rectal surgery to determine the possible effects of MBP.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
2.
Eagye KJ, Nicolau DP (2009) Deep and organ/space infections in patients undergoing elective colorectal surgery: incidence and impact on hospital length of stay and costs. Am J Surg 198:359–367CrossRefPubMed
3.
Guenaga KF, Matos D, Castro AA et al (2003) Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev 2:CD001544
4.
Snijders HS, Wouters MW, van Leersum NJ et al (2012) Meta-analysis of the risk for anastomotic leakage, the postoperative mortality caused by leakage in relation to the overall postoperative mortality. Eur J Surg Oncol 38:1013–1019CrossRefPubMed
5.
Khan AA, Wheeler JM, Cunningham C et al (2008) The management and outcome of anastomotic leaks in colorectal surgery. Colorectal Dis. 10:587–592CrossRefPubMed
6.
Chessin DB, Enker W, Cohen AM et al (2005) Complications after preoperative combined modality therapy and radical resection of locally advanced rectal cancer: a 14-year experience from a specialty service. J Am Coll Surg 200:876–882CrossRefPubMed
7.
Den Dulk M, Noter SL, Hendriks ER et al (2009) Improved diagnosis and treatment of anastomotic leakage after colorectal surgery. Eur J Surg Oncol 35:420–426CrossRef
8.
Hallböök O, Sjödahl R (1996) Anastomotic leakage and functional outcome after anterior resection of the rectum. Br J Surg 83:60–62CrossRefPubMed
9.
Nesbakken A, Nygaard K, Lunde OC (2001) Outcome and late functional results after anastomotic leakage following mesorectal excision for rectal cancer. Br J Surg 88:400–404CrossRefPubMed
10.
Law W, Choi HK, Lee YM et al (2007) Anastomotic leakage is associated with poor long-term outcome in patients after curative colorectal resection for malignancy. J Gastrointest Surg. 11:8–15CrossRefPubMed
11.
Mcardle CS, McMillan DC, Hole D (2005) Impact of anastomotic leakage on long-term survival of patients undergoing curative resection for colorectal cancer. Br J Surg 92:1150–1154CrossRefPubMed
12.
Walker KG, Bell SW, Rickard MJ et al (2004) Anastomotic leakage is predictive of diminished survival after potentially curative resection for colorectal cancer. Ann Surg 240:255–259CrossRefPubMedPubMedCentral
13.
Hammond J, Lim S, Wan Y et al (2014) The burden of gastrointestinal anastomotic leaks: an evaluation of clinical and economic outcomes. J Gastrointest Surg. 18:1176–1185CrossRefPubMedPubMedCentral
14.
Nichols RL, Condon RE (1971) Preoperative preparation of the colon. Surg Gynecol Obstet. 132:323–337PubMed
15.
Solla JA, Rothenberger DA (1990) Preoperative bowel preparation. A survey of colon and rectal surgeons. Dis Colon Rectum 33:154–159CrossRefPubMed
16.
Beck D, Fazio VW (1990) Current preoperative bowel cleansing methods. Results of a survey. Dis Colon Rectum 33:12–15CrossRefPubMed
17.
Markell KW, Hunt BM, Charron PD et al (2010) Prophylaxis and management of wound infections after elective colorectal surgery: a survey of the American Society of Colon and Rectal Surgeons membership. J Gastrointest Surg. 14:1090–1098CrossRefPubMed
18.
Bucher P, Gervaz P, Soravia C et al (2005) Randomized clinical trial of mechanical bowel preparation versus no preparation before elective left-sided colorectal surgery. Br J Surg 92:409–414CrossRefPubMed
19.
Slim K, Vicaut E, Launay-Savary MV et al (2009) Updated systematic review and meta-analysis of randomized clinical trials on the role of mechanical bowel preparation before colorectal surgery. Ann Surg 249:203–209CrossRefPubMed
20.
Jung B, Påhlman L, Nyström PO et al (2007) Multicentre randomized clinical trial of mechanical bowel preparation in elective colonic resection. Br J Surg 94:689–695CrossRefPubMed
21.
Bretagnol F, Panis Y, Rullier E et al (2010) Rectal cancer surgery with or without bowel preparation: the French GRECCAR III multicenter single-blinded randomized trial. Ann Sur 252:863–868CrossRef
22.
Burke P, Mealy K, Gillen P et al (1994) Requirement for bowel preparation in colorectal surgery. Br J Surg 81:907–910CrossRefPubMed
23.
Bucher P, Mermillod B, Gervaz P et al (2004) Mechanical bowel preparation for elective colorectal surgery: a meta-analysis. Arch Surg 139:1359–1364CrossRefPubMed
24.
Slim K, Vicaut E, Panis Y et al (2004) Meta-analysis of randomized clinical trials of colorectal surgery with or without mechanical bowel preparation. Br J Surg 91:1125–1130CrossRefPubMed
25.
Fa-Si-Oen P, Roumen R, Buitenweg J et al (2005) Mechanical bowel preparation or not? Outcome of a multicenter, randomized trial in elective open colon surgery. Dis Colon Rectum 48:1509–1516CrossRefPubMed
26.
Contant CM, Hop WC, van’t Sant HP et al (2007) Mechanical bowel preparation for elective colorectal surgery: a multicentre randomised trial. Lancet 370:2112–2117CrossRefPubMed
27.
Frizelle FA, Colls BM (2005) Hyponatremia and seizures after bowel preparation: report of three cases. Dis Colon Rectum 48:393–396CrossRefPubMed
28.
Beloosesky Y, Grinblat J, Weiss A et al (2003) Electrolyte disorders following oral sodium phosphate administration for bowel cleansing in elderly patients. Arch Intern Med 163:803–808CrossRefPubMed
29.
Gravante G, Caruso R, Andreani SM et al (2008) Mechanical bowel preparation for colorectal surgery: a meta-analysis on abdominal and systemic complications on almost 5000 patients. Int J Colorectal Dis 23:1145–1150CrossRefPubMed
30.
Zmora O, Wexner SD, Hajjar L et al (2003) Trends in preparation for colorectal surgery: survey of the members of the American Society of Colon and Rectal Surgeons. Am Surg 69:150–154PubMed
31.
Duxbury MS, Brodribb AJ, Oppong FC et al (2003) Management of colorectal cancer: variations in practice in one hospital. Eur J Surg Oncol 29:400–402CrossRefPubMed
32.
Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62:1006–1012CrossRefPubMed
33.
34.
Cooper H, Hedges L (1994) The handbook of research synthesis and meta-analysis, 2nd edn. Russell Sage Foundation, New York, p 632
35.
36.
Jørgensen L, Paludan-Müller AS, Laursen DRT et al (2016) Evaluation of the Cochrane tool for assessing risk of bias in randomized clinical trials: overview of published comments and analysis of user practice in Cochrane and non-Cochrane reviews. Syst Rev 5:80CrossRefPubMedPubMedCentral
37.
38.
Guyatt G, Vist G, Falck-Ytter Y et al (2006) An emerging consensus on grading recommendations? ACP J Club 144:A8–A9PubMed
39.
Schünemann HJ, Jaeschke R, Cook DJ et al (2006) An official ATS statement: grading the quality of evidence and strength of recommendations in ATS guidelines and recommendations. Am J Respir Crit Care Med 174:605–614CrossRefPubMed
40.
41.
Bhat AH, Parray FQ, Chowdri NA et al (2016) Mechanical bowel preparation versus no preparation in elective colorectal surgery: a prospective randomized study. Int J Surg Open 2:26–30CrossRef
42.
Bhattacharjee PK, Chakraborty S (2015) An open-label prospective randomized controlled trial of mechanical bowel preparation vs nonmechanical bowel preparation in elective colorectal surgery: personal experience. Indian J Surg 77:1233–1236CrossRefPubMedPubMedCentral
43.
Beerdawood KA, Alhmoud FD, Namoura AAA et al (2014) Primary colorectal anastomosis, no preparation, no stoma needed. J Bahrain Med Soc 25:93–97
44.
Saha AK, Chowdhury F, Jha AK et al (2014) Mechanical bowel preparation versus no preparation before colorectal surgery: a randomized prospective trial in a tertiary care institute. J Nat Sci Biol Med 5:421–424CrossRefPubMedPubMedCentral
45.
Kim YW, Choi EH, Kim IY et al (2014) The impact of mechanical bowel preparation in elective colorectal surgery: a propensity score matching analysis. Yonsei Med J 55:1273–1280CrossRefPubMedPubMedCentral
46.
Tahirkheli M, Shukr I, Iqbal R (2013) Anastomotic leak in prepared versus unprepared bowel. Gomal J Med Sci 11:73–77
47.
Sasaki J, Matsumoto S, Kan H et al (2012) Objective assessment of postoperative gastrointestinal motility in elective colonic resection using a radiopaque marker provides an evidence for the abandonment of preoperative mechanical bowel preparation. J Nippon Med Sch. 79:259–266CrossRefPubMed
48.
van’t Sant HP, Slieker JC, Hop WCJ et al (2012) The influence of mechanical bowel preparation in elective colorectal surgery for diverticulitis. Techn Coloproctol 16:309–314CrossRef
49.
Hu Y, Li K, Li L et al (2017) Early outcomes of elective surgery for colon cancer with preoperative mechanical bowel preparation: a randomized clinical trial. Nan Fang Yi Ke Da Xue Xue Bao 37:13–17PubMed
50.
Emir S, Kavlakoglu B, Yazar F (2012) Mechanical bowel preparation before colorectal surgery: is it necessary? Ulusal Cerrahi Dergisi 28(2):84–87
51.
Spanjersberg WR, Reurings J, Keus F et al (2011) Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev 2:CD007635
52.
Harbord RM, Egger M, Sterne JA (2006) A modified test for small-study effects in meta-analyses of controlled trials with binary endpoints. Stat Med 25:3443–3457CrossRefPubMed
53.
Anglemyer A, Horvath HT, Bero L (2014) Healthcare outcomes assessed with observational study designs compared with those assessed in randomized trials. Cochrane Database Syst Rev 4:MR000034
54.
Güenaga KF, Matos D, Wille-Jørgensen P (2011) Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev 1:CD001544
55.
Cao F, Li J, Li F (2012) Mechanical bowel preparation for elective colorectal surgery: updated systematic review and meta-analysis. Int J Colorectal Dis 27:803–810CrossRefPubMed
56.
Pineda CE, Shelton AA, Hernandez-Boussard T et al (2008) Mechanical bowel preparation in intestinal surgery: a meta-analysis and review of the literature. J Gastrointest Surg. 12:2037–2044CrossRefPubMed
57.
Wille-Jørgensen P, Guenaga KF, Matos D et al (2005) Pre-operative mechanical bowel cleansing or not? an updated meta-analysis. Color Dis. 7:304–310CrossRef
58.
Scarborough JE, Mantyh CR, Sun Z et al (2015) Combined mechanical and oral antibiotic bowel preparation reduces incisional surgical site infection and anastomotic leak rates after elective colorectal resection: an analysis of colectomy-targeted ACS NSQIP. Ann Surg 262:331–337CrossRefPubMed
59.
Moghadamyeghaneh Z, Hwang GS, Hanna MH et al (2016) Risk factors for prolonged ileus following colon surgery. Surg Endosc 30:603–609CrossRefPubMed
60.
Kiran RP, Murray ACA, Chiuzan C et al (2015) Combined preoperative mechanical bowel preparation with oral antibiotics significantly reduces surgical site infection, anastomotic leak, and ileus after colorectal surgery. Ann Surg 262:416–425CrossRefPubMed
61.
62.
Mahajna A, Krausz M, Rosin D et al (2015) Bowel preparation is associated with spillage of bowel contents in colorectal surgery. Dis Colon Rectum 48:1626–1631CrossRef
Metadaten
Titel
Effectiveness of mechanical bowel preparation versus no preparation on anastomotic leakage in colorectal surgery: a systematic review and meta-analysis
verfasst von
Jobbe P. L. Leenen
Judith E. K. R. Hentzen
Henrietta D. L. Ockhuijsen
Publikationsdatum
21.03.2018
Verlag
Springer International Publishing
Erschienen in
Updates in Surgery / Ausgabe 2/2019
Print ISSN: 2038-131X
Elektronische ISSN: 2038-3312
DOI
https://doi.org/10.1007/s13304-018-0526-4

Weitere Artikel der Ausgabe 2/2019

Updates in Surgery 2/2019 Zur Ausgabe

Original Article

Cytoreductive surgery followed by HIPEC repetition for secondary ovarian cancer recurrence

Editorial and Commentary

Surgery 2019: an existential crisis

Editorial and Commentary

Reform in the training of digestive surgeons in France: a revolution for a renaissance!

Letter to the Editor

Alternative uses of virtual simulators for laparoscopy and robot‐assisted surgery for medical students

Review Article

Prophylactic drainage after laparoscopic cholecystectomy for acute cholecystitis: a systematic review and meta-analysis

Editorial and Commentary

Bowel preparation in colorectal surgery: back to the future?

Neu im Fachgebiet Chirurgie

23.04.2024 | Ablationstherapie | Nachrichten

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

23.04.2024 | Appendizitis | Nachrichten

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 | Operationsvorbereitung | Nachrichten

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

19.04.2024 | EAU 2024 | Kongressbericht | Nachrichten

Ureterstriktur: Innovative OP-Technik bewährt sich
weitere anzeigen

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.