Shawn J Rangel1, Saleem Islam2, Shawn D St Peter3, Adam B Goldin4, Fizan Abdullah5, Cynthia D Downard6, Jacqueline M Saito7, Martin L Blakely8, Pramod S Puligandla9, Roshni Dasgupta10, Mary Austin11, Li Ern Chen12, Elizabeth Renaud13, Marjorie J Arca14, Casey M Calkins14. 1. Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: shawn.rangel@childrens.harvard.edu. 2. University of Florida College of Medicine, Gainesville, FL, USA. 3. Children's Mercy Hospital, University of Missouri, Kansas City, MO, USA. 4. Seattle Children's Hospital, University of Washington, Seattle, WA, USA. 5. Johns Hopkins School of Medicine, Baltimore, MD, USA. 6. University of Louisville, Louisville, KY, USA. 7. St. Louis Children's Hospital, Washington University, St. Louis, MO, USA. 8. Vanderbilt University Medical Center, Nashville, TN, USA. 9. Montreal Children's Hospital, Montreal, QC, Canada. 10. Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, OH, USA. 11. Children's Memorial Hermann Hospital, University of Texas, Houston, TX, USA. 12. Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA. 13. Children's Hospital at Montefiore, Bronx, NY, USA. 14. Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA.
Abstract
OBJECTIVE: This goal of this review was to examine the clinical evidence in support of commonly utilized measures intended to reduce complications following elective colorectal surgery. DATA SOURCE: Literature searches were performed to identify relevant studies from Medline, PubMed, and Cochrane databases. STUDY SELECTION: The American Pediatric Surgery Association Outcomes and Clinical Trials Committee selected eight questions to address this topic systematically in the context of three management areas: 1) appropriate utilization of systemic antibiotics for colorectal procedures, 2) reduction of stool burden through mechanical bowel preparation, and 3) intraluminal gut decontamination through use of enteral nonabsorbable antibiotics. Primary outcomes of interest included the occurrence of infectious and mechanical complications related to stool burden and intraluminal bacterial concentration (incisional surgical site infection, anastomotic leakage, and intraabdominal abscess). RESULTS: The evidence in support of each management category was systematically reviewed, graded, and summarized in the context of the review's primary outcomes. Practice recommendations were made as deemed appropriate by the committee. CONCLUSIONS: Clinical evidence in support of interventions to reduce infectious complications following colorectal surgery is derived almost exclusively from the adult literature. High-quality evidence to guide clinical practice in children is sorely needed, as the available data may have only limited relevance to pediatric colorectal diseases.
OBJECTIVE: This goal of this review was to examine the clinical evidence in support of commonly utilized measures intended to reduce complications following elective colorectal surgery. DATA SOURCE: Literature searches were performed to identify relevant studies from Medline, PubMed, and Cochrane databases. STUDY SELECTION: The American Pediatric Surgery Association Outcomes and Clinical Trials Committee selected eight questions to address this topic systematically in the context of three management areas: 1) appropriate utilization of systemic antibiotics for colorectal procedures, 2) reduction of stool burden through mechanical bowel preparation, and 3) intraluminal gut decontamination through use of enteral nonabsorbable antibiotics. Primary outcomes of interest included the occurrence of infectious and mechanical complications related to stool burden and intraluminal bacterial concentration (incisional surgical site infection, anastomotic leakage, and intraabdominal abscess). RESULTS: The evidence in support of each management category was systematically reviewed, graded, and summarized in the context of the review's primary outcomes. Practice recommendations were made as deemed appropriate by the committee. CONCLUSIONS: Clinical evidence in support of interventions to reduce infectious complications following colorectal surgery is derived almost exclusively from the adult literature. High-quality evidence to guide clinical practice in children is sorely needed, as the available data may have only limited relevance to pediatric colorectal diseases.
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