BACKGROUND: The discussion on the role of mechanical bowel preparation and oral antibiotics in elective colorectal surgery is still ongoing. OBJECTIVE: This meta-analysis aimed to determine whether oral systemic antibiotics with mechanical bowel preparation are superior to systemic antibiotics and mechanical bowel preparation for prophylaxis of bacterial infection during elective colorectal operation. DATA SOURCES: Embase, PubMed, and the Cochrane Library were searched using the terms oral, antibiotics/antimicrobial, colorectal/rectal/colon/rectum, and surgery/operation. STUDY SELECTION: All of the available randomized controlled trials that compared the efficacy of combined oral and systemic antibiotics and mechanical bowel preparation with systemic antibiotics alone and mechanical bowel preparation in colorectal surgery and defined surgical site infection based on Centers for Disease Control and Prevention criteria were included. INTERVENTION: All of the statistical analyses were performed using Review Manager 5.2 software. A fixed model was used if there was no evidence of heterogeneity; otherwise, a random-effects model was used. MAIN OUTCOME MEASURES: We focused on incidence of surgical site infection among the groups. RESULTS: Seven randomized controlled trials that consisted of 1769 cases were eligible for analysis. We found that both total surgical site infection and incisional surgical site infection were significantly reduced in patients who received oral systemic antibiotics and mechanical bowel preparation compared with patients who received systemic antibiotics alone and mechanical bowel preparation (total: 7.2% vs 16.0%, p < 0.00001; incisional: 4.6% vs 12.1%, p < 0.00001). However, no significant difference was detected in the rate of organ/space surgical site infection (4.0% vs 4.8%; p = 0.56) after elective colorectal surgery. LIMITATIONS: The meta-analysis was limited by the risk of bias because a majority of the studies did not use the blinding method. CONCLUSIONS: Oral systemic antibiotics and mechanical bowel preparation significantly lowered the incidence of surgical site infection after elective colorectal surgery compared with systemic antibiotics alone and mechanical bowel preparation.
BACKGROUND: The discussion on the role of mechanical bowel preparation and oral antibiotics in elective colorectal surgery is still ongoing. OBJECTIVE: This meta-analysis aimed to determine whether oral systemic antibiotics with mechanical bowel preparation are superior to systemic antibiotics and mechanical bowel preparation for prophylaxis of bacterial infection during elective colorectal operation. DATA SOURCES: Embase, PubMed, and the Cochrane Library were searched using the terms oral, antibiotics/antimicrobial, colorectal/rectal/colon/rectum, and surgery/operation. STUDY SELECTION: All of the available randomized controlled trials that compared the efficacy of combined oral and systemic antibiotics and mechanical bowel preparation with systemic antibiotics alone and mechanical bowel preparation in colorectal surgery and defined surgical site infection based on Centers for Disease Control and Prevention criteria were included. INTERVENTION: All of the statistical analyses were performed using Review Manager 5.2 software. A fixed model was used if there was no evidence of heterogeneity; otherwise, a random-effects model was used. MAIN OUTCOME MEASURES: We focused on incidence of surgical site infection among the groups. RESULTS: Seven randomized controlled trials that consisted of 1769 cases were eligible for analysis. We found that both total surgical site infection and incisional surgical site infection were significantly reduced in patients who received oral systemic antibiotics and mechanical bowel preparation compared with patients who received systemic antibiotics alone and mechanical bowel preparation (total: 7.2% vs 16.0%, p < 0.00001; incisional: 4.6% vs 12.1%, p < 0.00001). However, no significant difference was detected in the rate of organ/space surgical site infection (4.0% vs 4.8%; p = 0.56) after elective colorectal surgery. LIMITATIONS: The meta-analysis was limited by the risk of bias because a majority of the studies did not use the blinding method. CONCLUSIONS: Oral systemic antibiotics and mechanical bowel preparation significantly lowered the incidence of surgical site infection after elective colorectal surgery compared with systemic antibiotics alone and mechanical bowel preparation.
Authors: Maria B Schiavone; Lea Moukarzel; Kam Leong; Qin C Zhou; Anoushka M Afonso; Alexia Iasonos; Kara Long Roche; Mario M Leitao; Dennis S Chi; Nadeem R Abu-Rustum; Oliver Zivanovic Journal: Gynecol Oncol Date: 2017-07-19 Impact factor: 5.482
Authors: Amir Elhassan; Ihab Elhassan; Amjad Elhassan; Krish D Sekar; Ryan E Rubin; Richard D Urman; Elyse M Cornett; Alan David Kaye Journal: Curr Pain Headache Rep Date: 2019-03-11
Authors: Joseph C Carmichael; Deborah S Keller; Gabriele Baldini; Liliana Bordeianou; Eric Weiss; Lawrence Lee; Marylise Boutros; James McClane; Scott R Steele; Liane S Feldman Journal: Surg Endosc Date: 2017-08-03 Impact factor: 4.584
Authors: Manuela Elia-Guedea; Elena Cordoba-Diaz de Laspra; Estibaliz Echazarreta-Gallego; María Isabel Valero-Lazaro; Jose Manuel Ramirez-Rodriguez; Vicente Aguilella-Diago Journal: Int J Colorectal Dis Date: 2017-03-31 Impact factor: 2.571
Authors: James Wei Tatt Toh; Kevin Phan; Grahame Ctercteko; Nimalan Pathma-Nathan; Toufic El-Khoury; Arthur Richardson; Gary Morgan; Reuben Tang; Mingjuan Zeng; Susan Donovan; Daniel Chu; Gregory Kennedy; Kerry Hitos Journal: Int J Colorectal Dis Date: 2018-09-20 Impact factor: 2.571