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Improved Outcomes in Colon and Rectal Surgery part 5

Improved Outcomes in Colon and Rectal Surgery part 5. Written by many of the worlds leading colorectal surgeons, this evidence-based text investigates the risks and benefits of colorectal surgeries. By using clinical pathways, algorithms, and case discussions, the authors identify the best practices for patient safety and positive outcomes to ensure that physicians correctly recognize potential problems and carefully manage complications | improved outcomes in colon and rectal surgery oral antibiotic prophylaxis in colon surgery 8 compared three oral doses to one oral dose to no oral antibiotics. Patients in all three groups received intravenous cefoxitin before incision and two doses after surgery ended. They found no benefit to the oral antibiotics and indeed found that patients randomized to three doses of oral medications had lower tolerance of the prep. They concluded that there is no benefit to oral antibiotics assuming that appropriate intravenous antibiotics are given. The long-standing practice of mechanical bowel preparations before surgery to decrease the fecal load has also come under closer scrutiny in the past decade. Multiple case series were reported which led to randomized trials in the 1990s and early 2000s. A meta-analysis in 2004 9 demonstrated in an evaluation of five such randomized trials that mechanical bowel preparation did not improve outcome or decrease the risk of surgical site infection. They concluded that mechanical bowel preparation might be omitted but that further studies should be performed. A recently published Cochrane Database Review 10 further concluded that there is not good evidence that mechanical bowel preparation reduces the risk of anastomotic and infectious complications. Furthermore although the data does not support conclusively that mechanical bowel preparation can be deleterious there is some evidence to that point. All in all the authors felt that routine mechanical bowel preparation should be reconsidered. A recent multiinstitutional randomized trial also showed similar results leading the authors to conclude that routine mechanical bowel preparation is unnecessary. ll Two large multiinstitu-tional randomized trials recently published also showed similar outcomes between patients receiving bowel preparation and those not receiving one. 12 13 Close evaluation of the data from these two trials does however raise concern that the lack of a bowel .