The best bowel preparation before colorectal surgery to avoid postoperative complications Using stored data of subjects (N = 27,804) from the American College of Surgeons National Surgical Quality Improvement Program; the authors of a recent paper publish in Annals of Surgery compare four different approaches:All patients receive intravenous antibiotics prior to surgery. Patients with prior infection; anesthesia class V poor-risk patients, patients requiring emergency surgery; and patients with missing data are exclude.
Requiring emergency surgery
The results showed significant benefit for those patients receiving both preoperative MBP and ABP treatment (P < .001 for all outcomes). These benefits included reduce surgical-site and organ-space infection; less frequent wound dehiscence, and less frequent anastomotic leakage. There was no evidence that combined preoperative MBP and ABP increased the risk for Clostridium difficile infection.
Wound healing is a complex and dynamic process of replacing devitalized and missing cellular structures and tissue layers. The human adult wound healing process divide into 3 or 4 distinct phases. Earlier authors referred to 3 phases inflammatory; fibroblastic, and maturation, which has also been denote as inflammatory; proliferation, and remodeling and this is maintained by some authors.
In the 4-phases concept, there are the hemostasis phase, the inflammatory phase, the proliferation phase, and the remodeling phase. In the 3-phases approach, the hemostasis phase is contain within the inflammatory phase. Not only do authors vary the number of phases, but authors also denote differences in the phase descriptors used as: hemostasis phase, inflammatory phase, proliferation phase, and remodeling phase or hemostasis phase, inflammatory phase, granulation phase, and maturation phase.
Therefore, certain phases have more than one name, such as remodeling or maturation and proliferation or granulation. As our understanding of wound healing progresses, further phases and subphases may well be delineated. Throughout most of the 20th century, mechanical bowel prep along with oral antibiotics was a widely used method to promote bowel sterility before colon and rectal excision.
The Preoperative bowel
Since that time, there have been numerous trials either confirming or questioning the individual or combined use of a mechanical bowel prep or oral antibiotics. What does this recent report add First, it reveals that with various preoperative strategies available to them, 38% of surgeons in this large sample rely upon oral antibiotics combined with preoperative bowel cleansing. In contrast, only 23% of surgeons preferred no preoperative treatment.
Although the results clearly favor dual preoperative preparation, there are several caveats. The chief problem is that this was not a randomized trial; the authors attempted to select similar patients in the various groups, a less robust method than a randomized trial.