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Colorectal Dis. 2018 Sep;20 Suppl 6:15-32. doi: 10.1111/codi.14362.

Association of mechanical bowel preparation with oral antibiotics and anastomotic leak following left sided colorectal resection: an international, multi-centre, prospective audit.

Collaborators (1368)

Glasbey JC, Blanco-Colino R, Kelly M, Singh B, Bhangu A, Pinkney T, Poskus T, El-Hussuna A, Battersby NJ, Buchs NC, Buskens C, Chaudri S, Frasson M, Gallo G, Minaya-Bravo AM, Morton D, Negoi I, Nepogodiev D, Pata F, Sánchez-Guillén L, Zmora O, Perry R, Magill L, Altomare D, Bemelman W, Brown S, Denost Q, Knowles C, Laurberg S, Lefevre JH, Möeslein G, Pinkney T, Vaizey C, Bilali S, Bilali V, Salomon M, Cillo M, Estefania D, Patron Uriburu J, Ruiz H, Farina P, Carballo F, Guckenheimer S, Proud D, Brouwer R, Bui A, Nguyen B, Smart P, Warwick A, Theodore JE, Herbst F, Birsan T, Dauser B, Ghaffari S, Hartig N, Stift A, Argeny S, Unger L, Strouhal R, Heuberger A, Varabei A, Lahodzich N, Makhmudov A, Selniahina L, Feryn T, Leupe T, Maes L, Reynvoet E, Van Langenhove K, Nachtergaele M, Monami B, Francart D, Jehaes C, Markiewicz S, Weerts J, Van Belle K, Bomans B, Cavenaile V, Nijs Y, Vertruyen M, Pletinckx P, Claeys D, Defoort B, Muysoms F, Van Cleven S, Lange C, Vindevoghel K, Wolthuis A, D'Hoore A, Todorovic M, Dabic S, Kenjic B, Lovric S, Vidovic J, Delibegovic S, Mehmedovic Z, Christiano A, Lombardi B, Marchiori M Jr, Tercioti V Jr, Dardanov D, Petkov P, Simonova L, Yonkov A, Zhivkov E, Maslyankov S, Pavlov V, Sokolov M, Todorov G, Stoyanov V, Batashki I, Iarumov N, Lozev I, Moshev B, Slavchev M, Atanasov B, Belev N, Krstev P, Penkov R, Šantak G, Ćosić J, Previšić A, Vukušić L, Zukanović G, Zelić M, Kršul D, Lekić Vitlov V, Mendrila D, Orhalmi J, Dusek T, Maly O, Paral J, Sotona O, Skrovina M, Bencurik V, Machackova M, Kala Z, Farkašová M, Grolich T, Procházka V, Hoch J, Kocian P, Martinek L, Antos F, Pruchova V, El-Hussuna A, Ceccotti A, Madsbøll T, Straarup D, Uth Ovesen A, Christensen P, Bondeven P, Edling P, Elfeki H, Alexandrovich Gameza V, Michelsen Bach S, Zheltiakova I, Krarup PM, Krogh A, Rolff HC, Lykke J, Juvik AF, Lóven HHK, Marckmann M, Osterkamp JTF, Madsen AH, Worsøe J, Ugianskis A, Kjaer MD, Youn Cho Lee B, Khalid A, Kristensen MH, El Sorogy M, Elgeidie A, Elhemaly M, El Nakeeb A, Elrefai M, Shalaby M, Emile S, Omar W, Sakr A, Thabet W, Awny S, Metwally I, Refky B, Shams N, Zuhdy M, Lepistö A, Keränen I, Kivelä A, Lehtonen T, Siironen P, Rautio T, Ahonen-Siirtola M, Klintrup K, Paarnio K, Takala H, Hyöty M, Haukijärvi E, Kotaluoto SM, Lehto K, Tomminen T, Huhtinen H, Carpelan A, Karvonen J, Rantala A, Varpe P, Cotte E, Francois Y, Glehen O, Passot G, d'Alessandro A, Chouillard E, Etienne JC, Ghilles E, Vinson-Bonnet B, Germain A, Ayav A, Bresler L, Chevalier R, Denost Q, Didailler R, Rullier E, Tiret E, Chafai N, Lefevre JH, Parc Y, Sielezneff I, Mege D, Lakkis Z, Barussaud M, Krones C, Bock B, Webler R, Baral J, Lang T, Münch S, Pullig F, Schön M, Hinz S, Becker T, Möller T, Richter F, Schafmayer C, Hardt J, Kienle P, Crescenti F, Ahmad M, Soleiman Y, Papaconstantinou I, Gklavas A, Nastos K, Theodosopoulos T, Vezakis A, Stamou K, Saridaki A, Xynos E, Paraskakis S, Zervakis N, Skroubis G, Amanatidis T, Germanos S, Maroulis I, Papadopoulos G, Dimitriou N, Alexandrou A, Felekouras E, Griniatsos J, Karavokyros I, Papadopoulos A, Chouliaras C, Ioannidis P, Katsounis D, Kefalou E, Katsoulis IE, Balalis D, Korkolis DP, Manatakis D, Tzovaras G, Baloyiannis I, Mamaloudis I, Lázár G, Ábraham S, Paszt A, Simonka Z, Tóth I, Zaránd A, Baranyai Z, Ferreira G, Harsányi L, Ónody P, Banky B, Burány Á, Lakatos M, Marton J, Solymosi A, Besznyák I, Bursics A, Papp G, Saftics G, Svastics I, Valsdottir E, Atladottir J, Jonsson T, Moller P, Sigurdsson H, Gupta SK, Gupta S, Kaul N, Mohan S, Sharma G, Wani R, Chowdri N, Khan M, Mehraj A, Parray FQ, Coveney A, Burke J, Deasy J, El-Masry S, McNamara D, Khan MF, Cahill R, Faul E, Mulsow J, Shields C, Kelly ME, Bass G, Martin ST, O'Connell R, Ryan E, Connelly T, Ahmad G, Bukhari W, Cooke F, Zmora O, Gold Deutch R, Haim N, Lavy R, Moscovici A, Shussman N, Gefen R, Marom G, Pikarsky A, Weiss D, Avital S, Hermann N, Raguan B, Slavin M, White I, Wasserberg N, Arieli H, Gurevich N, Freund MR, Dorot S, Edden Y, Halfteck G, Reissman P, Edden Y, Pery R, Tulchinsky H, Weizman A, Agresta F, Curinga R, Finotti E, Savino G, Verza LA, Asteria CR, Boccia L, Pascariello A, Tamini N, Bugatti A, Gianotti L, Totis M, Vincenti L, Andriola V, Giannini I, Travaglio E, Balestri R, Buccianti P, Roffi N, Rossi E, Urbani L, Mellano A, Cinquegrana A, Lauretta A, Belluco C, Mistrangelo M, Allaix ME, Arolfo S, Morino M, Testa V, Delrio P, Pace U, Rega D, Scala D, Gallo G, Clerico G, Cornaglia S, Realis Luc A, Trompetto M, Ugolini G, Antonacci N, Fabbri S, Montroni I, Zattoni D, D'Urbano C, Cornelli A, Viti M, Inama M, Bacchion M, Casaril A, Impellizzeri H, Moretto G, Spinelli A, Carvello M, David G, Di Candido F, Sacchi M, Frontali A, Ceriani V, Molteni M, Rosati R, Aleotti F, Elmore U, Lemma M, Vignali A, Scabini S, Casoni Pattacini G, Luzzi A, Romairone E, Marino F, Lorusso D, Pezzolla F, Colombo F, Baldi C, Foschi D, Sampietro G, Sorrentino L, Di Saverio S, Birindelli A, Segalini E, Spacca D, Romano GM, Belli A, Bianco F, De Franciscis S, Falato A, Muratore A, Marsanic P, Grimaldi S, Castaldo N, Ciolli MG, Picarella P, Porfidia R, Tugnoli G, Bondurri A, Cavallo D, Maffioli A, Pertusati A, Pulighe F, Balestra F, De Nisco C, Podda M, Opocher E, Longhi M, Mariani NM, Maroni N, Pisani Ceretti A, Galleano R, Aonzo P, Curletti G, Reggiani L, Marconi M, Del Prete L, Oldani M, Pappalardo R, Zaccone L S, Scatizzi M, Baraghini M, Cantafio S, Feroci F, Giani I, Tutino R, Cocorullo G, Gulotta G, Licari L, Salamone G, Sileri P, Saraceno F, La Torre F, Chirletti P, Coletta D, De Toma G, Mingoli A, Papandrea M, De Luca E, Sacco R, Sammarco G, Vescio G, Tonini V, Bianchini S, Cervellera M, Vaccari S, Cracco N, Barugola G, Bertocchi E, Rossini R, Ruffo G, Sartori A, Clemente N, De Luca M, De Luca A, Scaffidi G, Lorenzon L, Balducci G, Bocchetti T, Ferri M, Mercantini P, Pata F, Bauce S, Benevento A, Bottini C, Crapa PR, Rubbini M, Anania G, Carcoforo P, Cavallesco G, Feo C, Yamamoto T, Sivins A, Ancans G, Gerkis S, Lunis R, Pcolkins A, Venskutonis D, Bradulskis S, Dainius E, Subocius A, Vencius J, Zeromskas P, Eismontas V, Nutautiene V, Simcikas D, Tamosiunas A, Svagzdys S, Latkauskas T, Lizdenis P, Saladzinskas Z, Tamelis A, Dulskas A, Kuliavas J, Samalavicius NE, Poskus T, Jotautas V, Mikalauskas S, Poskus E, Strupas K, Zakaria AD, Lah NN, Wong M, Zain WZ, Zakaria Z, Mazlan L, Mohd Azman ZA, Sagap I, Psaila J, Andrejevic P, Cini C, Ellul S, Pace K, Ahallat M, Hamid M, Hrora A, Majbar MA, Raiss M, Westerduin E, Bemelman W, Buskens C, Tanis P, van der Sluis PC, Davids PH, Pronk A, Schiphorst AHW, Smakman N, Zimmerman D, Koeter T, Stijns J, van Loon YT, Vermaas M, de Graaf E, Doornebosch P, van Hagen P, van Ruler O, Toorenvliet B, Nonner J, van den Berg I, van Steensel L, Vles W, Melenhorst J, Orsini R, Visschers R, Hoff C, Blom R, Marsman H, Mulder I, Cense H, de Castro S, Demirkiran A, Hunfeld M, van Geloven A, de Groof J, Hendriks E, Leeuwenburg M, van Oorschot N, Wit F, Rupert C, Veldman P, Keijzers M, Konsten J, Den Boer F, Corver M, Boerma EG, Koolen L, Martens M, Van Wijck K, Ignjatovic D, Breuer R, Gurpreet B, Oresland T, Tetens Moe T, Nesbakken A, Flaaten Backe I, Wik TA, Radiya K, Dehli T, Gjessing P, Norderval S, Woll K, Anwer M, Qureshi MS, Qureshi AU, Billah M, Jawad MY, Raza A, Urooj N, Wang X, Li L, Jajtner D, Gasinski B, Kabiesz W, Walega P, Romaniszyn M, Zawadzki M, Czarnecki R, Obuszko Z, Rzaca M, Sitarska M, Silva P, Duarte A, Gonçalves D, Morais M, Rama N, Nobre J, Sales I, Costa Pereira J, Costa S, Costa Pereira C, Insua C, Romero I, Figueiredo N, Cunha J, Domingos H, Vieira P, Cunha M, Americano M, Amorim E, Rachadell J, Carvas JM, Armas I, Fernandes P, Pires C, Reis R, Martins R, Dos Santos M, Henriques P, Oliveira O, Duarte M, Ferreira L, Miranda J, Vilela N, Corte Real J, Carlos S, Frois Borges M, Moniz Pereira P, Simões J, Silva-Vaz P, Bettencourt V, Gouveia A, Perez H, Rainho R, Bintintan V, Ciuce C, Dindelegan G, Scurtu R, Seicean R, Cristian D, Burcos T, Grama F, Mandi DM, Richiteanu G, Miron A, Calu V, Enciu O, Nadragea M, Parvuletu R, Mogoanta SS, Crafciuc A, Paitici S, Negoi I, Beuran M, Ciubotaru C, Prodan A, Vartic M, Tomulescu V, Copaescu C, Yanishev A, Abelevich A, Kokobelyan A, Lebedeva M, Luzan R, Pozdnyakov A, Cherdancev D, Mahotin D, Nesytykh A, Samsonyuk V, Pravosudov I, Ivlev D, Karachun A, Lebedev K, Samsonov D, Aiupov R, Feoktistov D, Garipov M, Suleymanov N, Tarasov N, Rasulov A, Dzhumabaev H, Mamedli Z, Bedzhanyan A, Popov D, Sednev A, Klimenko A, Semenov A, Vasilyev S, Khazov A, Khanevich M, Khrykov G, Katorkin S, Andreev P, Chernov A, Davidova O, Zhuravlev A, Achkasov S, Shakhmatov D, Shelygin Y, Sushkov O, Vardanyan A, Ilkanich A, Barbashinov N, Darvin V, Onishchenko S, Voronin Y, Krivokapić Z, Barišić G, Dimitrijević I, Marković V, Sekulić A, Stanojevic G, Brankovic B, Nestorovic M, Pecic V, Petrovic D, Kostic I, Aleksic A, Dabic D, Maric B, Perunicic V, Radovanovic Z, Djuric M, Lukic D, Radovanovic D, Cuk V, Juloski J, Kenic M, Krdzic I, Ngu JC, Ng YY, Teo N, Korcek J, Lazorisak A, Rems M, Ramovš Trampuš Š, Tomazic A, Grosek J, Kosir J, Norcic G, Vigorita V, Caceres N, Casal E, Ruano A, Trostchansky I, Golda T, Galvez Saldaña A, Kreisler Moreno E, Lopez Dominguez J, Vila Tura M, Labarga F, Galvez P, Maderuelo V, Suero C, Bargallo J, Cayetano L, Lamas S, Silva MC, Bernal-Sprekelsen JC, Gómez R, Jareño S, Ríos A, Vercher D, García-González JM, Cervera-Aldama J, Ramos-Prada J, Santamaría-Olabarrieta M, Borda N, Enrriquez-Navascués JM, Saralegui Y, Calero-Lillo A, Aznar-Puig S, López-Lara MA, Muñoz-Collado S, Valverde-Sintas J, Menendez P, Leon C, Truan N, Baldonedo R, Fernández-Martínez D, Otero J, Solar-García L, Turrado-Rodriguez V, de Lacy Oliver F, Lacy Fortuny AM, Martin Perez B, Otero Piñeiro AM, Paredes J, Fernandez F, Ladra MJ, Paulos A, Prieto D, Beltrán de Heredia JP, Blanco Antona F, de Andrés Asenjo B, Ferreras García C, Romero de Diego A, Cordoba Diaz de Laspra E, Echazarreta Gallego E, Elia Guedea M, Escola D, Martinez S, Primo Romaguera V, Parreño R, Pastor L, Rosell E, Lozoya Trujillo R, Alós Company R, Ruiz Carmona MD, Solana Bueno A, Salvans Ruiz S, Alonso Gonçalves S, Jiménez-Toscano M, Pascual Damieta M, Pera Roman M, Pellicer-Franco EM, Garcia-Marin JA, Mengual-Ballester M, Soria-Aledo V, Valero-Navarro G, Vicente-Ruiz M, Garcia-Zamora C, Gonzalez-Gil A, Montoya-Tabares MJ, Paredes-Quiles M, Die Trill J, Abadia P, Moreno I, Pina JD, Ramos Rubio D, Escartin J, Blas JL, Fernando J, Ferrer R, Garcia Egea J, Pros I, Martinez W, Rius J, Socías M, Sabia D, Castellvi Valls J, Gonzalez Santin V, Mompart Garcia S, Viso Pons L, Julià D, Codina-Cazador A, Farrés R, Gómez N, Planellas P, Cuadrado M, Camps I, Rufas M, Escoll J, Fermiñán A, Muriel P, Sierra E, Alvarez-Laso C, Lora P, Padin H, Garcia-Septiem J, Bustamante C, Jimenez V, Jimenez-Miramon J, Ramos JL, Gallardo AB, Benito P, Colao L, Galindo P, Garcia C, Forero-Torres A, Alonso Poza A, Dieguez Fernandez B, Gilsanz Martin C, Hernandez Garcia M, Rojo López JA, Gil López JM, González Zunzárren M, Martínez Alegre J, Zorrilla Matilla LP, Navarro-Sánchez A, Alcalá Serrano FJ, López-Fernández J, Montesdeoca Cabrera D, Alvarez-Gallego M, Guevara J, Pascual Miguelañez I, Rubio-Perez I, Gomez Ruiz M, Alonso Martín J, Cagigas Fernández C, Castillo Diego J, Pando JA, Maristany C, Muñoz-Duyos A, Rada-Palomino A, Vargas-Pierola H, Peña Ros E, Benavides Buleje JA, Muñoz Camarena JM, Parra Baños PA, Ramirez Faraco M, Arenal JJ, Citores MA, Marcos JL, Sánchez J, Tinoco C, García Flórez LJ, Arias Pacheco RD, Mínguez Ruiz G, Gutiérrez Corral N, Rodríguez Infante A, Carrillo López MJ, Carrasco Prats MM, Lage Laredo A, Martínez Manzano Á, Rodríguez García P, Segura-Sampedro JJ, Alonso-Hernández N, Fernandez Isart M, Gamundi Cuesta M, Ochogavia Segui A, Ibañez N, Abrisqueta J, Lujan J, Gómez Pérez R, Corrales Valero E, Monje Salazar C, Sanchiz Cardenas E, Soler Humanes R, Jimenez-Rodriguez RM, De la Portilla F, Diaz Pavon JM, Garcia Cabrera AM, Reyes Diaz ML, Espin E, Marinello F, Martí M, Sanchez JL, Vallribera F, Orts Mico FJ, Ortin Navarro M, Perez Climent M, Serra Diaz C, Millan M, Caro A, Escuder J, Espina B, Feliu F, Climent Aira A, Estévez Diz A, Moreno Asencio MT, Varela Mato A, Vázquez Bouzán R, Minaya-Bravo AM, Diez-Alonso MM, Villeta-Plaza R, Guadalajara H, Alías D, García Olmo D, Pastor C, Valverde I, Sanchez Romero A, Gardea A, Gil Santos M, Nimmersgern T, Serrano Paz P, Romero-Simó M, Blasco-Segura T, Caravaca-García I, Costa-Navarro D, Zarco-Pleguezuelos A, Sánchez-Guillén L, Flor-Lorente B, Frasson M, García-Granero Á, García-Granero E, Arencibia B, Alonso J, Febles G, Nogués EM, Roque C, Segelman J, Nygren J, Nestler G, Abraham-Nordling M, Egenvall M, Myrelid P, Jung B, Loftås P, Lydrup ML, Azahr N, Buchwald P, Mangell P, Syk I, Nikberg M, Carlander J, Chabok A, Smedh K, Tiselius C, Haapaniemi S, Benckert A, Adamina M, Freil-Lanter C, Gingert C, Müller P, Schäfli J, Regusci L, Brenna M, Fasolini F, Misteli H, Kirchhoff P, Oertli D, Hahnloser D, Clerc D, Hübner M, Ris F, Buchs NC, Chevallay M, Morel P, Schiltz B, Wang JY, Su WC, Huang CW, Ma CJ, Tsai HL, Bugra D, Agalar F, Baloglu H, Basoglu I, Okkabaz N, Binboga E, Biricik A, Celik A, Yavuz E, Canda AE, Agalar C, Fuzun M, Sokmen S, Terzi C, Isik A, Karip B, Bilgili AC, Leventoğlu S, Aytac B, Küçükdiler E, Yıldız A, Yuksel O, Sinan H, Hancerliogullari O, Kaymak S, Kozak O, Ozer MT, Sarici IS, Akca O, Kalayci MU, Kara Y, Agcaoglu O, Balik E, Bayram O, Özbalcı GS, Özkan BB, Karabacak U, Sungurtekin U, Ozgen U, Demirbas S, Öztürk E, Isik O, Yilmazlar T, Colak E, Karagul S, Kinas V, Fearnhead N, Lord I, Stewart P, Zammit M, Arnold S, Battersby NJ, Broadhurst J, Moran S, Seretis F, Shabbir J, Jones C, Kynaston J, Vimalachandran D, Blower E, McFaul C, McWhirter D, Pilkington J, Wilson T, Chowdhary M, Stubbs B, Abdalkoddus M, Lai C, Thavanesan N, Yao C, Agarwal T, Dindyal 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Mothe S, Rahman M, Curtis N, Allison A, Dalton R, Francis N, Ockrim J, Psaras G, Dudarovaska H, Marharint T, Mostovoy E, Voloshin S, Kolesnik O, Makhmudov D, Altinel Y, Iqbal A, Cunningham L, Go K, Tan S.

Abstract

INTRODUCTION:

The optimal bowel preparation strategy to minimise the risk of anastomotic leak is yet to be determined. This study aimed to determine whether oral antibiotics combined with mechanical bowel preparation (MBP+Abx) was associated with a reduced risk of anastomotic leak when compared to mechanical bowel preparation alone (MBP) or no bowel preparation (NBP).

METHODS:

A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 Left Sided Colorectal Resection audit was performed. Patients undergoing elective left sided colonic or rectal resection with primary anastomosis between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak.

RESULTS:

Of 3676 patients across 343 centres in 47 countries, 618 (16.8%) received MBP+ABx, 1945 MBP (52.9%) and 1099 patients NBP (29.9%). Patients undergoing MBP+ABx had the lowest overall rate of anastomotic leak (6.1%, 9.2%, 8.7% respectively) in unadjusted analysis. After case-mix adjustment using a mixed-effects multivariable regression model, MBP+Abx was associated with a lower risk of anastomotic leak (OR 0.52, 0.30-0.92, P = 0.02) but MBP was not (OR 0.92, 0.63-1.36, P = 0.69) compared to NBP.

CONCLUSION:

This non-randomised study adds 'real-world', contemporaneous, and prospective evidence of the beneficial effects of combined mechanical bowel preparation and oral antibiotics in the prevention of anastomotic leak following left sided colorectal resection across diverse settings. We have also demonstrated limited uptake of this strategy in current international colorectal practice.

KEYWORDS:

Colorectal surgery; anastomotic leak; bowel preparation; colonic cancer; laparoscopic surgery

PMID:
30255646
DOI:
10.1111/codi.14362

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