Fewer complications after rectal resection with mechanical bowel prep, oral antibiotics
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Key takeaways:
- Mechanical bowel preparation and oral antibiotics resulted in fewer overall postoperative complications vs. mechanical prep alone.
- Fewer surgical site infections and anastomotic dehiscences were also reported.
Mechanical bowel preparation and oral antibiotics reduced postoperative complications, including surgical site infection and dehiscence, vs. mechanical bowel preparation alone in patients undergoing elective rectal resection, data showed.
“Several retrospective studies from the American College of Surgeons National Surgical Quality Improvement Program reignited the debate almost a decade ago and suggested that mechanical and oral antibiotic bowel preparation (MOABP) is associated with lower rates of [surgical site infections (SSIs)] in colorectal surgery compared with only mechanical bowel preparation (MBP) or no bowel preparation,” Laura Koskenvuo, MD, PhD, of the department of gastroenterological surgery at Helsinki University Hospital, and colleagues wrote in JAMA Surgery.
“To our knowledge, no high-quality, large, double-blind randomized clinical trial assessing MOABP in rectal resection has been published.”
To determine whether MOABP reduces overall complications and SSIs compared with MBP plus placebo, Koskenvuo and colleagues conducted a multicenter, double-blind, placebo-controlled trial of 565 patients who underwent elective resection with primary anastomosis of a rectal tumor (≤ 15 cm) between March 2020 and October 2022.
Patients were grouped according to tumor distance from the anal verge and preoperative treatment received and randomized to receive either MOABP with an oral regimen of neomycin and metronidazole (n = 277; median age, 70 years; 57% men) or MBP with matching placebo (n = 288; median age, 69 years; 66% men). All patients received IV antibiotics approximated 30 minutes before surgery.
The primary studied outcome was overall cumulative postoperative complications within 30 days of surgery, measured by the Comprehensive Complication Index, while secondary outcomes included SSI and anastomotic dehiscence.
According to study results, there were fewer overall postoperative complications among patients in the MOABP group compared with the MBP plus placebo group (median CCI, 0 vs. 8.66) with no complications reported in 56% vs. 46.5%, respectively.
Further, patients in the MOABP group experienced fewer SSIs (8.3% vs. 16.7%; OR = 0.45; 95% CI, 0.27-0.77) and anastomotic dehiscences (5.8% vs. 13.5%; OR = 0.39; 95% CI, 0.21-0.72).
“The results of this randomized clinical trial indicate that MOABP resulted in fewer overall postoperative complications as well as fewer SSIs and anastomotic dehiscences in patients undergoing elective rectal resection compared with MBP alone,” Koskenvuo and colleagues wrote. “Based on these findings, MOABP should be considered as standard treatment in patients undergoing elective rectal resection.”
They continued: “Further follow-up of the patients included in this trial will shed light on the long-term, especially oncological, outcomes after MOABP vs. MBP.”
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