Pre-operative mechanical bowel cleansing or not? an updated meta-analysis

Pre-operative mechanical bowel cleansing or not? an updated meta-analysis

Autor Wille-Jorgensen, P. Google Scholar
Guenaga, Katia Ferreira Google Scholar
Matos, Delcio Autor UNIFESP Google Scholar
Castro, Aldemar Araujo Autor UNIFESP Google Scholar
Instituição Bispebjerg Hosp
Universidade Federal de São Paulo (UNIFESP)
Resumo Objectives Pre-operative mechanical bowel preparation has been considered an efficient regimen against leakage and infectious complications, after colorectal resections. This dogma is based only on observational data and experts' opinions. the aim of this study was to evaluate the efficacy and safety of prophylactic pre-operative mechanical bowel preparation before elective colorectal surgery.Methods: EMBASE, LILACS, MEDLINE and the Cochrane Library and abstracts from major gastroenterological congresses were searched. No language restrictions were applied. the selection criterion used was randomised clinical trials (RCT) comparing any kind of mechanical bowel preparation with no preparation in patients submitted to elective colorectal surgery and where anastomotic leakage, mortality, and wound infection were outcome measurements. Data were independently extracted by the reviewers and cross-checked. the methodological quality of each trial was assessed by the same reviewers. for meta-analysis the Peto-Odds ratio was used.Results: of 1592 patients (9 RCTs), 789 were allocated to mechanical bowel preparation (Group A) and 803 to no preparation (Group B) before elective colorectal surgciy. Anastomotic leakage developed in 48 (6%) of 772 patients in A compared with 25 (3.2%) of 777 patients in B; Peto OR 2.03, 95% (CI: 1.28-3.26; P = 0.003). Wound infection occurred in 59 (7.4%) of 791 patients in A and in 43 (5.4%) of 803 patients in B; Peto OR 1.46, 95% (CI: 0.97-2.18; P = 0.07);Five (1%) of 5 09 patients died in group in A compared with 3 (0.61 %) of 516 patients in group B; Peto OR 1.72, 95% (CI: 0.43-6.95; nonsignificant).Conclusion:There is no evidence that patients benefit from mechanical bowel preparation. On the contrary taking colorectal surgery as a whole, pre-operative bowel cleansing leads to a higher rate of anastomotic leakage. the dogma that mechanical bowel preparation is necessary before elective colorectal surgery has to be reconsidered.
Palavra-chave cleansing
pre-operative
colorectal
bowel preparation
Idioma Inglês
Data de publicação 2005-07-01
Publicado em Colorectal Disease. Oxford: Blackwell Publishing, v. 7, n. 4, p. 304-310, 2005.
ISSN 1462-8910 (Sherpa/Romeo, fator de impacto)
Publicador Blackwell Publishing
Extensão 304-310
Fonte http://dx.doi.org/10.1111/j.1463-1318.2005.00804.x
Direito de acesso Acesso aberto Open Access
Tipo Resenha
Web of Science WOS:000232648500002
Endereço permanente http://repositorio.unifesp.br/handle/11600/28357

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