Iesalnieks, Igors and Hoene, Melanie and Bittermann, Theresa and Schlitt, Hans J. and Hackl, Christina (2018) Mechanical Bowel Preparation (MBP) Prior to Elective Colorectal Resections in Crohn's Disease Patients. INFLAMMATORY BOWEL DISEASES, 24 (4). pp. 908-915. ISSN 1078-0998, 1536-4844
Full text not available from this repository. (Request a copy)Abstract
Background: Studies addressing the role of mechanical bowel preparation (MBP) in Crohn's disease (CD) patients are lacking. Methods: Consecutive elective colorectal resections for CD have been included in the present analysis. Exclusion criteria were small bowel resections not including colon, urgent surgeries, surgeries for cancer, and abdominoperineal resections for perianal disease. MBP was performed routinely between 1992 and 2004, omitted between 2005 and 2015, and reintroduced in 2016. Intraabdominal septic complications (IASC) were anastomotic leakage, intraabdominal abscess, intestinal fistula, and peritonitis. Results: Overall, 680 bowel resections for CD have been performed between 1992 and 2017. After exclusion of the above mentioned patients, 549 patients were included in the present analysis. The IASC rate was 12% in patients undergoing surgery after MPB as opposed to 24% when MBP was omitted (P < 0.001). By the multivariate analysis, preoperative MBP significantly reduced the risk of IASC (Hazard ratio 0.45; 95% CI, 0.23 - 0.86; P = 0.016). Preoperative weight loss (HR 2.0; 95% CI, 1.1 - 3.6; P = 0.024), penetrating disease (HR 2.6; 95% CI, 1.3 - 5.4; P = 0.01), and stapled as opposed to hand-sewn ileocolic anastomosis (HR 3.3; 95% CI, 1.4 - 7.7; P = 0.006) were associated with an increased risk of IASC. The positive impact of MBP was strongest on anastomotic complication rate in patients undergoing ileocolic resections for penetrating disease (11% vs 36%, P < 0.001). Conclusion: Preoperative MPB should be strongly considered before colorectal surgery in patients with CD, especially in patients undergoing ileocolic resections for penetrating disease.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | INTRAABDOMINAL SEPTIC COMPLICATIONS; SURGICAL SITE INFECTION; ORAL ANTIBIOTICS; ILEOCECAL RESECTION; ANASTOMOTIC LEAK; RISK-FACTORS; SURGERY; OPERATIONS; COLON; PROPHYLAXIS; Crohn's disease; intestinal resection; bowel preparation |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Chirurgie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 19 Mar 2020 07:56 |
| Last Modified: | 19 Mar 2020 07:56 |
| URI: | https://pred.uni-regensburg.de/id/eprint/14858 |
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