Marie Strøm Zangenberg1, Nir Horesh2, Uri Kopylov3, Alaa El-Hussuna4. 1. Department of Surgery, Zealand University Hospital, Køge, Denmark. 2. Department of Surgery, Sheba Medical Center, Tel Hashomer and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. 3. Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. 4. Department of Surgery, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark. alaa@itu.dk.
Abstract
PURPOSE: Surgical management of inflammatory bowel disease (IBD) is a challenging task. The aim of preoperative optimization (PO) is to decrease the risk of complications and reduce the length of postoperative stay. The aim of this study was to review and grade the available evidence, attain clear recommendations, and point out potential future research. METHODS: Studies were identified from electronic databases (PubMed, Embase, and Cochrane Library) and scanning reference lists in relevant papers. English-written studies examining PO in adult patients with IBD were included. Eight PO factors were investigated. RESULTS: Management of IBD is a multidisciplinary task. Steroid withdrawal is recommended while steroid stress dose is not recommended. Thiopurines appear to be safe, but it may be prudent to plan the procedure remotely from the last dose of an anti-TNF agent. Nutritional risk screening is recommended to unveil and correct any malnutrition. Thrombosis prophylaxis prior to surgery is well supported by evidence while extended 4-week prophylaxis needs further research. Percutaneous ultrasound or CT-guided drainage for intra-abdominal abscesses is recommended, but it is unclear for how long supplementary antibiotics (ABs) should be used. Oral AB 24 h prior to open surgery might improve outcome if given as complementary to IV perioperative AB. Mechanical bowel preparation is not supported by evidence. Comorbidities must be treated accordingly prior to surgical intervention. Smoking cessation can be beneficial for wound healing. CONCLUSION: Multimodel PO intervention in IBD patients is recommended.
PURPOSE: Surgical management of inflammatory bowel disease (IBD) is a challenging task. The aim of preoperative optimization (PO) is to decrease the risk of complications and reduce the length of postoperative stay. The aim of this study was to review and grade the available evidence, attain clear recommendations, and point out potential future research. METHODS: Studies were identified from electronic databases (PubMed, Embase, and Cochrane Library) and scanning reference lists in relevant papers. English-written studies examining PO in adult patients with IBD were included. Eight PO factors were investigated. RESULTS: Management of IBD is a multidisciplinary task. Steroid withdrawal is recommended while steroid stress dose is not recommended. Thiopurines appear to be safe, but it may be prudent to plan the procedure remotely from the last dose of an anti-TNF agent. Nutritional risk screening is recommended to unveil and correct any malnutrition. Thrombosis prophylaxis prior to surgery is well supported by evidence while extended 4-week prophylaxis needs further research. Percutaneous ultrasound or CT-guided drainage for intra-abdominal abscesses is recommended, but it is unclear for how long supplementary antibiotics (ABs) should be used. Oral AB 24 h prior to open surgery might improve outcome if given as complementary to IV perioperative AB. Mechanical bowel preparation is not supported by evidence. Comorbidities must be treated accordingly prior to surgical intervention. Smoking cessation can be beneficial for wound healing. CONCLUSION: Multimodel PO intervention in IBDpatients is recommended.
Entities:
Keywords:
Colorectal; Inflammatory bowel disease; Multimodel intervention; Optimization; Surgery
Authors: P Zerbib; D Koriche; S Truant; A F Bouras; G Vernier-Massouille; D Seguy; F R Pruvot; A Cortot; J F Colombel Journal: Aliment Pharmacol Ther Date: 2010-05-22 Impact factor: 8.171
Authors: George E Reese; Theodore Nanidis; Catherine Borysiewicz; Takayuki Yamamoto; Timothy Orchard; Paris P Tekkis Journal: Int J Colorectal Dis Date: 2008-09-02 Impact factor: 2.571
Authors: G Pellino; D S Keller; G M Sampietro; V Annese; M Carvello; V Celentano; C Coco; F Colombo; N Cracco; F Di Candido; M Franceschi; S Laureti; G Mattioli; L Pio; G Sciaudone; G Sica; V Villanacci; R Zinicola; S Leone; S Danese; A Spinelli; G Delaini; F Selvaggi Journal: Tech Coloproctol Date: 2020-01-25 Impact factor: 3.781
Authors: Christian Galata; Peter Kienle; Christel Weiss; Steffen Seyfried; Christoph Reißfelder; Julia Hardt Journal: Int J Colorectal Dis Date: 2018-11-20 Impact factor: 2.571
Authors: Lucy Burns; Michael E Kelly; Maria Whelan; James O'Riordan; Paul Neary; Dara O Kavanagh Journal: Ir J Med Sci Date: 2022-01-17 Impact factor: 1.568
Authors: Michiel T J Bak; Marit F E Ruiterkamp; Oddeke van Ruler; Marjo J E Campmans-Kuijpers; Bart C Bongers; Nico L U van Meeteren; C Janneke van der Woude; Laurents P S Stassen; Annemarie C de Vries Journal: World J Gastroenterol Date: 2022-06-14 Impact factor: 5.374
Authors: Lukas Walter Unger; Stefan Riss; Stanislaus Argeny; Michael Bergmann; Thomas Bachleitner-Hofmann; Friedrich Herbst; Anton Stift Journal: Wien Klin Wochenschr Date: 2019-03-06 Impact factor: 1.704
Authors: A El-Hussuna; M L M Karer; N N Uldall Nielsen; A Mujukian; P R Fleshner; I Iesalnieks; N Horesh; U Kopylov; H Jacoby; H M Al-Qaisi; F Colombo; G M Sampietro; M V Marino; M Ellebæk; C Steenholdt; N Sørensen; V Celentano; N Ladwa; J Warusavitarne; G Pellino; A Zeb; F Di Candido; L Hurtado-Pardo; M Frasson; L Kunovsky; A Yalcinkaya; O C Tatar; S Alonso; M Pera; A G Granero; C A Rodríguez; A Minaya; A Spinelli; N Qvist Journal: BJS Open Date: 2021-09-06
Authors: Patrick L Stoner; Amir Kamel; Fares Ayoub; Sanda Tan; Atif Iqbal; Sarah C Glover; Ellen M Zimmermann Journal: Gastroenterol Res Pract Date: 2018-09-23 Impact factor: 2.260