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In the 21st Century: What is the role of mechanical bowel preparation in colorectal resection ?

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Nick Rieger Associate Professor University of Adelaide South Australia

Salud y medicina
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In the 21 st Century: What is the role of mechanical bowel preparation in colorectal resection ? ,[object Object],[object Object],[object Object],[object Object]
Mechanical Bowel Preps ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What I do! ,[object Object],[object Object],[object Object],[object Object],[object Object]
Why? ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
A recent case! ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The evidence: Study 1 Guenaga et al. Mechanical bowel preparation for elective colorectal surgery. Cochrane database 2005 1159 patients with anastomosis (6 RCT) Group 1 - 576 prep Group 2 - 583 no prep
The evidence: Study 1 OR 1.94 CI 1.09-3.43 P = 0.02 OR 1.75 CI 0.18-17.02 OR 1.17 CI 0.35-3.96 NS 17/583 (2.9%) 1/166 (0.6%) 6/50 (12%) Gp 2 32/576 (5.5%) 2/172 (1.16%) 6/48 (12.5%) Gp 1 Overall Colonic LAR Anastomotic leak
The evidence: Study 1 35/609 (5.7%) NS 0/326 (0%) NS Group 2 44/595 (7.4%) 2/329 (0.6%) Group 1 Wound Infection Mortality
The evidence: Study 1 ,[object Object],[object Object],[object Object]
The evidence : Study 2 ,[object Object],[object Object],[object Object],[object Object]
The evidence : Study 2 OR 1.72 CI 0.43-6.95 NS OR 1.46 CI 0.97-2.18 P = 0.07 OR 2.03 CI 1.28-3.26 P = 0.003 3/516 (0.6%) 43/803 (5.4%) 25/777 (3.2%) Group 2 No Prep 5/509 (1%) 59/791 (7.4%) 48/772 (6%) Group 1 Prep Mortality Wound Infection Leak
The evidence : Study 2 ,[object Object],[object Object]
The evidence : Study 3 ,[object Object],[object Object],[object Object],[object Object],[object Object]
The evidence : Study 3 ,[object Object],[object Object]
Australian NHMRC Guidelines 2005 ,[object Object],[object Object],[object Object]
ASCRS 2006 Seattle ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
“ Fast Track Surgery” ,[object Object],[object Object],[object Object],[object Object]
“ Fast Track Surgery” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
“ Fast Track Surgery” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
“ Fast Track Surgery” ,[object Object],[object Object],[object Object],[object Object]
“ Fast Track Surgery” Prehab Surgery Rehab Post-rehab Preoperative Optimization No Preoperative Optimization Minimally invasive + Preoperative Optimization
Summary ,[object Object],[object Object],[object Object],[object Object]

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In the 21st Century: What is the role of mechanical bowel preparation in colorectal resection ?

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  • 8. The evidence: Study 1 Guenaga et al. Mechanical bowel preparation for elective colorectal surgery. Cochrane database 2005 1159 patients with anastomosis (6 RCT) Group 1 - 576 prep Group 2 - 583 no prep
  • 9. The evidence: Study 1 OR 1.94 CI 1.09-3.43 P = 0.02 OR 1.75 CI 0.18-17.02 OR 1.17 CI 0.35-3.96 NS 17/583 (2.9%) 1/166 (0.6%) 6/50 (12%) Gp 2 32/576 (5.5%) 2/172 (1.16%) 6/48 (12.5%) Gp 1 Overall Colonic LAR Anastomotic leak
  • 10. The evidence: Study 1 35/609 (5.7%) NS 0/326 (0%) NS Group 2 44/595 (7.4%) 2/329 (0.6%) Group 1 Wound Infection Mortality
  • 11.
  • 12.
  • 13. The evidence : Study 2 OR 1.72 CI 0.43-6.95 NS OR 1.46 CI 0.97-2.18 P = 0.07 OR 2.03 CI 1.28-3.26 P = 0.003 3/516 (0.6%) 43/803 (5.4%) 25/777 (3.2%) Group 2 No Prep 5/509 (1%) 59/791 (7.4%) 48/772 (6%) Group 1 Prep Mortality Wound Infection Leak
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  • 23. “ Fast Track Surgery” Prehab Surgery Rehab Post-rehab Preoperative Optimization No Preoperative Optimization Minimally invasive + Preoperative Optimization
  • 24.