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Mechanical Bowel Preparations Not Beneficiary
Mechanical bowel preparations
before surgery: a standard of care,
yet doubtful effect; © SXC
Mechanical bowel preparations (MBP) are commonly administered preoperatively to patients who undergo a pancreaticoduodenectomy (PD) to treat benign and malignant tumors of the pancreas, common bile duct or duodenum.
MBPs are employed as a preventative measure in gastrointestinal surgery but their effectiveness in reducing perioperative infectious complications remains unclear. Now, a research team has concluded MBPs offer no clinical benefit to patients undergoing a pancreaticoduodenectomy.
The researchers performed a retrospective review in which they analyzed clinical data from 100 consecutive PDs performed on patients receiving preoperative MBP from March 2006 to April 2007, and compared them to 100 consecutive patients who received a preoperative clear liquid diet (CLD) from May 2007 to March 2008. They found that there were no significant differences between the MBP and CLD groups in the rates of pancreatic fistula, intra-abdominal abscess or wound infection. There were trends toward increased urinary tract infections and Clostridium difficile infections with the MBP group. The median length of postoperative hospital stay was seven days in each group and the twelve-month survival rates were equivalent.
“Based upon these data and similar results from numerous randomized prospective trials in colon and rectal surgery, we feel that patients have improved therapeutic outcomes without MBP prior to PD and we have excluded it from our practice,” said Harish Lavu of the Department of Surgery and lead author of the study. “Given the recent influx of national and institutional quality improvement projects, it is appropriate to define the need and efficacy of mechanical bowel preparations for pancreaticoduodenectomy if it is to remain in clinical practice.”
MBP has been thought of as an essential factor for avoiding infectious complications and anastomotic dehiscence, most commonly in colon surgery. This is based upon the belief that MBP reduces the volume of solid or semi-solid contents at the time of surgery, theoretically reducing bacterial load, and the risk of intraoperative enteric spillage. MBP has become a standard of care across many surgical disciplines involving the gastrointestinal tract, including foregut surgery.
MEDICA.de; Source: Thomas Jefferson University