Mechanical bowel preparation for elective colorectal surgery

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dc.contributor.author Guenaga, Katia K. F. G. [UNIFESP]
dc.contributor.author Matos, Delcio [UNIFESP]
dc.contributor.author Wille-Jorgensen, Peer
dc.date.accessioned 2016-01-24T13:52:02Z
dc.date.available 2016-01-24T13:52:02Z
dc.date.issued 2009-01-01
dc.identifier http://dx.doi.org/10.1002/14651858.CD001544.pub3
dc.identifier.citation Cochrane Database of Systematic Reviews. Chichester: John Wiley & Sons Ltd, n. 1, 50 p., 2009.
dc.identifier.issn 1469-493X
dc.identifier.uri http://repositorio.unifesp.br/handle/11600/31139
dc.description.abstract BackgroundThe presence of bowel contents during surgery has been related to anastomotic leakage, but the belief that mechanical bowel preparation (MBP) is an efficient agent against leakage and infectious complications is based on observational data and expert opinions only.ObjectivesTo determine the security and effectiveness of MBP on morbidity and mortality in colorectal surgery.Search strategyPublications describing trials of MBP before elective colorectal surgery were sought through searches of MEDLINE, EMBASE, LILACS, and T h e Coch ran e Library; by handsearching relevant medical journals and conference proceedings, and through personal communication with colleagues.Searches were performed March 13, 2008.Selection criteriaRandomised controlled trials (RCTs) including participants submitted for elective colorectal surgery. Eligible interventions included any type of MBP compared with no MBP. Primary outcomes included anastomosis leakage - both rectal and colonic - and combined figures. Secondary outcomes included mortality, peritonitis, reoperation, wound infection, extra-abdominal complications, and overall surgical site infections.Data collection and analysisData were independently extracted and checked. the methodological quality of each trial was assessed. Details of randomisation, blinding, type of analysis, and number lost to follow up were recorded. for analysis, the Peto-Odds Ratio (OR) was used as the default (no statistical heterogeneity was observed).Main resultsFour new trials were included at this update (total 13 RCTs with 4777 participants; 2390 allocated to MBP (Group A), and 2387 to no preparation (Group B), before elective colorectal surgery).Anastomotic leakage occurred:(i) in 10.0% (14/139) of Group A, compared with 6.6% (9/136) of Group B for low anterior resection; Peto OR 1.73 (95% confidence interval (CI): 0.73 to 4.10).(ii) in 2.9% (32/1226) of Group A, compared with 2.5% (31/1228) of Group B for colonic surgery; Peto OR 1.13 (95% CI: 0.69 to 1.85).Overall anastomotic leakage occurred in 4.2% (102/2398) of Group A, compared with 3.4% (82/2378) of Group B; Peto OR 1.26 (95% CI: 0.941 to 1.69).Wound infection occurred in 9.6% (232/2417) of Group A, compared with 8.3% (200/2404) of Group B; Peto OR 1.19 (95% CI: 0.98 to 1.45).Sensitivity analyses did not produce any differences in overall results.Authors' conclusionsThere is no statistically significant evidence that patients benefit from MBP. the belief that MBP is necessary before elective colorectal surgery should be reconsidered. Further research on patients submitted for elective colorectal surgery in whom bowel continuity is restored, with stratification for colonic and rectal surgery, is still warranted. en
dc.format.extent 50
dc.language.iso eng
dc.publisher Wiley-Blackwell
dc.relation.ispartof Cochrane Database of Systematic Reviews
dc.rights Acesso restrito
dc.title Mechanical bowel preparation for elective colorectal surgery en
dc.type Resenha
dc.rights.license http://olabout.wiley.com/WileyCDA/Section/id-406071.html
dc.contributor.institution Universidade Federal de São Paulo (UNIFESP)
dc.contributor.institution Bispebjerg Hosp
dc.description.affiliation Universidade Federal de São Paulo, Dept Surg Gastroenterol, BR-11440050 São Paulo, Brazil
dc.description.affiliation Universidade Federal de São Paulo, Brazilian Cochrane Ctr, São Paulo, Brazil
dc.description.affiliation Bispebjerg Hosp, Dept Surg Gastroenterol K, Copenhagen, Denmark
dc.description.affiliationUnifesp Universidade Federal de São Paulo, Dept Surg Gastroenterol, BR-11440050 São Paulo, Brazil
dc.description.affiliationUnifesp Universidade Federal de São Paulo, Brazilian Cochrane Ctr, São Paulo, Brazil
dc.identifier.doi 10.1002/14651858.CD001544.pub3
dc.description.source Web of Science
dc.identifier.wos WOS:000263035400065



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