Association of mechanical bowel preparation with oral antibiotics and anastomotic leak following left sided colorectal resection: an international, multi‐centre, prospective audit. (25th September 2018)

• Record Type: Journal Article
• Other Names: Glasbey James C. investigator.; Blanco‐Colino Ruth investigator.; Kelly Michael investigator.; Singh Baljit investigator.; Bhangu Aneel investigator.; Pinkney Thomas investigator.; Poskus Tomas investigator.; El‐Hussuna Alaa investigator.; Battersby Nick J. investigator.; Buchs Nicolas C. investigator.; Buskens Christianne investigator.; Chaudri Sanjay investigator.; Frasson Matteo investigator.; Gallo Gaetano investigator.; Minaya‐Bravo Ana María investigator.; Morton Dion investigator.; Negoi Ionut investigator.; Nepogodiev Dmitri investigator.; Pata Francesco investigator.; Sánchez‐Guillén Luis investigator.; Zmora Oded investigator.; Perry Rita investigator.; Magill Laura investigator.; Altomare Donato investigator.; Bemelman Willem investigator.; Brown Steven investigator.; Denost Quentin investigator.; Knowles Charles investigator.; Laurberg Søren investigator.; Lefevre Jérémie H. investigator.; Möeslein Gabriela investigator.; Pinkney Tom investigator.; Vaizey Carolynne investigator.; Bilali S. investigator.; Bilali V. investigator.; Salomon M. investigator.; Cillo M. investigator.; Estefania D. investigator.; Patron Uriburu J. investigator.; Ruiz H. investigator.; Farina P. investigator.; Carballo F. investigator.; Guckenheimer S. investigator.; Proud D. investigator.; Brouwer R. investigator.; Bui A. investigator.; Nguyen B. investigator.; Smart P. investigator.; Warwick A. investigator.; Theodore J. 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U. investigator.; Bhan C. investigator.; Mukhtar H. investigator.; Oshowo A. investigator.; Wilson J. investigator.; Gouvas N. investigator.; Nicol D. investigator.; Pandey S. investigator.; Zilvetti M. investigator.; Sharma A. investigator.; Fatayer T. investigator.; Mothe S. investigator.; Rahman M. investigator.; Curtis N. investigator.; Allison A. investigator.; Dalton R. investigator.; Francis N. investigator.; Ockrim J. investigator.; Psaras G. investigator.; Dudarovaska H. investigator.; Marharint T. investigator.; Mostovoy E. investigator.; Voloshin S. investigator.; Kolesnik O. investigator.; Makhmudov D. investigator.; Altinel Y. investigator.; Iqbal A. investigator.; Cunningham L. investigator.; Go K. investigator.; Tan S. investigator.;
• Is Part Of: Colorectal disease. Volume 20(2018)Supplement 6
• Page Start: 15
• Page End: 32
• Publication Date: 2018-09-25
• Subjects: Colorectal surgery -- colonic cancer -- laparoscopic surgery -- bowel preparation -- anastomotic leak; Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; 616.34
• DOI: 10.1111/codi.14362
• Languages: English
• ISSNs: 1462-8910

Abstract

Abstract: Introduction: The optimal bowel preparation strategy to minimise the risk of anastomotic leak is yet to be determined. This study aimed to determine whether oral antibiotics combined with mechanical bowel preparation (MBP+Abx) was associated with a reduced risk of anastomotic leak when compared to mechanical bowel preparation alone (MBP) or no bowel preparation (NBP). Methods: A pre‐planned analysis of the European Society of Coloproctology (ESCP) 2017 Left Sided Colorectal Resection audit was performed. Patients undergoing elective left sided colonic or rectal resection with primary anastomosis between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak. Results: Of 3676 patients across 343 centres in 47 countries, 618 (16.8%) received MBP+ABx, 1945 MBP (52.9%) and 1099 patients NBP (29.9%). Patients undergoing MBP+ABx had the lowest overall rate of anastomotic leak (6.1%, 9.2%, 8.7% respectively) in unadjusted analysis. After case‐mix adjustment using a mixed‐effects multivariable regression model, MBP+Abx was associated with a lower risk of anastomotic leak (OR 0.52, 0.30–0.92, P = 0.02) but MBP was not (OR 0.92, 0.63–1.36, P = 0.69) compared to NBP. Conclusion: This non‐randomised study adds 'real‐world', contemporaneous, and prospective evidence of the beneficial effects of combined mechanical bowel preparation and oral antibiotics in the prevention of anastomotic leak following left sided colorectal resection across diverse settings. We have also demonstrated limited uptake of this strategy in current international colorectal practice. Abstract : See page27–32 for full print list. All collaborating authors will be listed in the online edition, and be PubMed citable