Mechanical Bowel Preparation for Children Undergoing Elective Colorectal Surgery Use of mechanical bowel preparation and oral antibiotics for elective colorectal procedures in children: is current practice evidence-based? Variation in bowel preparation among pediatric surgeons for elective colorectal surgery: A problem of equipoise or a knowledge gap of the available clinical evidence? Effect of preadmission bowel preparation on outcomes of elective colorectal procedures in young children. Elective intestinal operations in infants and children without mechanical bowel preparation: a pilot study. Multicentre randomized clinical trial of mechanical bowel preparation in elective colonic resection Is mechanical bowel preparation mandatory for elective colon surgery? A prospective randomized study. Rectal cancer surgery without mechanical bowel preparation Rectal Cancer Surgery With or Without Bowel Preparation: The French Greccar III Multicenter Single-Blinded Randomized Trial Bowel preparation with oral polyethylene glycol electrolyte solutionvs. no preparation in elective open colorectal surgery Preoperative mechanical preparation of the colon: the patient's experience Evaluation of necessity for mechanical bowel preparation before Milligan-Morgan hemorrhoidectomy: a randomized prospective clinical study. The Use of Mechanical Bowel Preparation in Pelvic Reconstructive Surgery: A Randomized Controlled Trial A Randomized Control Trial of Preoperative Oral Antibiotics as Adjunct Therapy to Systemic Antibiotics for Preventing Surgical Site Infection in Clean Contaminated, Contaminated, and Dirty Type of Colorectal Surgeries The duration of postoperative ileus after elective colectomy is correlated to surgical specialization Prophylaxis with whole gut irrigation and antimicrobials in colorectal surgery. A prospective, randomized double-blind clinical trial. Survey of pediatric surgeons on current practices of bowel preparation for elective colorectal surgery in children. Prophylactic antibiotics in elective colorectal surgery Combination of Oral Antibiotics and Mechanical Bowel Preparation Reduces Surgical Site Infection in Colorectal Surgery. Preoperative bowel preparation in children: Polyethylene glycol versus normal saline Randomized Trial on Fast Track Care in Colorectal Surgery for Deep Infiltrating Endometriosis. Requirement for bowel preparation in colorectal surgery A prospective, randomized trial of perioperative prophylactic cefamandole in elective colorectal surgery for malignancy
Objectives : Adult literature supports the elimination of mechanical bowel preparation ( MBP ) for elective colorectal surgical procedures . Prospect i ve data for the pediatric population regarding the utility of MBP are lacking . The primary aim of this study was to compare infectious complications , specifically anastomotic leak , intraabdominal abscess , and wound infection in patients who received MBP  with those who did not . Methods : A r and omized pilot study comparing MBP with polyethylene glycol with no MBP was performed . Patients , 0 to 21 years old , undergoing elective colorectal surgery were eligible and r and omized within 4 age strata . Statistical analyses were performed using & khgr;2 or Fisher exact test for categorical data and t test or Wilcoxon 2- sample test for continuous data . Results : Forty-four patients were enrolled in the study from December 2010 to February 2013 , of which 24 ( 55 % ) received  MBP and 20 ( 45 % ) did not . Two patients ( 5 % ) had anastomotic leak , 4 ( 9 % ) had intraabdominal infection , and 7 ( 16 % ) had wound infections . The rate of anastomotic leak , intraabdominal abscess , and wound infection did not differ between the 2 groups . Conclusions : MBP for elective colorectal surgery in children does not affect the incidence of infectious complications . A larger multiinstitutional study is necessary to vali date the results of this single-institution pilot study PURPOSE It is well established through r and omized trials that oral antibiotics given with or without a mechanical bowel preparation ( MBP ) prior to colorectal procedures reduce complications , while MBP given alone provides no benefit . We aim ed to characterize trends surrounding bowel preparation in children and determine whether contemporary practice is evidence -based . METHODS Retrospective analysis of patients undergoing colorectal procedures at 42 children 's hospitals ( 1/2/2007 - 12/31/2011 ) was performed . Patients were analyzed for diagnosis , pre-admission status , and inpatient bowel preparation .  Bowel preparation was considered evidence -based if oral antibiotics were utilized with or without a MBP . RESULTS 49 % of all patients were pre-admitted ( n=5,473 ) , and the most common diagnoses were anorectal malformations ( 55 % ) , inflammatory bowel disease ( 26 % ) , and Hirschsprung 's Disease ( 19 % ) . The most common preparation approaches were MBP alone ( 54.3 % ) , MBP+oral antibiotics ( 18.8 % ) , and oral antibiotics alone ( 4.2 % ) , although significant variation was found in hospital-specific rates for each approach ( MBP alone : 0 - 96.1 % , MBP+oral antibiotics : 0 - 83.6 % , orals alone : 0 - 91.6 % , p<0.0001 ) . Only 22.9 % of all patients received an evidence -based preparation ( range by hospital : 0 - 92.3 % , p<0.0001 ) , and this rate decreased significantly during the five-year study period ( 27.6 % in 2007 vs. 17.3 % in 2011 , p<0.0001 ) . CONCLUSION According to the best available clinical evidence , less than a quarter of all children pre-admitted for elective colorectal procedures receive a bowel preparation proven to reduce infectious complications PURPOSE Despite rigorous data from adult literature demonstrating that oral antibiotics ( OA ) reduce infectious complications and mechanical bowel preparation ( MBP ) alone does not , MBP alone remains the preferred approach among pediatric surgeons . We aim ed to explore the nature of this discrepancy through a survey of the American Pediatric Surgical Association membership . METHODS Surgeons were queried for their choice of bowel preparation , factors influencing their practice , and their impression of the strength and relevance of the adult literature to pediatric practice . RESULTS Surgeons who used MBP alone ( 31 % ) cited a reduction in stool burden and infectious complications as important factors , whereas surgeons choosing not to use OA ( 70 % ) reported a lack of benefit in reducing infectious complications as the primary reason . Although 53 % of surgeons reported that evidence from adult literature was the most important influence , 73 % of surgeons reported there was poor evidence supporting the use of OA ( ±MBP ) , and only 25 % used a preparation supported by adult r and omized data . CONCLUSIONS Wide variation exists among pediatric surgeons in the perceived utility of MBP and OA . Although the majority of pediatric surgeons cited the adult literature as the strongest influence on their practice , this is not consistent with stated perceptions or practice BACKGROUND The utility of mechanical bowel preparation ( MBP ) to minimize infectious complications in elective colorectal surgery is contentious . Though data is scarce in children , adult studies suggest a benefit to MBP when administered with oral antibiotics ( OAB ) . METHODS After IRB approval , the Pediatric Health Information System ( PHIS ) was queried for young children undergoing elective colon surgery from 2011 to 2014 . Patients were divided into : no bowel preparation ( Group 1 ) , MBP ( Group 2 ) , and MBP plus OAB ( Group 3 ) . Statistical significance was determined using univariate and multivariate analysis with GEE models accounting for clustering by hospital . RESULTS One thous and five hundred eighty-one patients met study criteria : 63.7 % in Group 1 , 27.1 % in Group 2 , and 9.2 % in Group 3 .  Surgical complication rate was higher in Group 1 ( 23.3 % ) compared to Groups 2 and 3 ( 14.2 % and 15.5 % ; P<0.001 ) . However , median length of stay was shorter in Group 1 ( 4 , IQR 4days ) compared to Group 2 ( 5 , IQR 3 ) and Group 3 ( 6 , IQR 3 ) ( P<0.001 ) . 30-day readmission rates were similar . In multivariate analysis compared to patients in Group 1 , the odds of surgical complications were 0.72 ( 95 % CI 0.40 - 1.29 , P=0.28 ) with MBP alone ( Group 2 ) , 1.79 ( 95 % CI 1.28 - 2.52 , P=0.0008 ) with MBP+OAB ( Group 3 ) , and 1.13 ( 95 % CI 0.81 - 1.58 , P=0.46 ) for the aggregate Group 2 plus 3 . CONCLUSION Utilization of bowel preparation in children is variable across children 's hospitals nationally , and the benefit is unclear . Given the discrepancy with adult literature , a three-armed pediatric-specific r and omized controlled trial is warranted . LEVEL OF EVIDENCE Level III treatment study - retrospective comparative study BACKGROUND / PURPOSE Preoperative mechanical bowel preparation ( MBP ) for elective intestinal operations has been a long accepted practice . However , MBP is often unpleasant and time-consuming for patients , and clinical trials in adults have not shown improved outcomes . We conducted this pilot study to test whether omitting MBP before elective intestinal operations in infants and children would increase the risk of infectious or anastomotic complications . METHODS Retrospective review was performed of 143 patients who had an elective colon or distal small bowel procedure performed at our children 's hospital between 1990 and 2003 . RESULTS Thirty-three patients ( No PREP ) were managed by a single surgeon who routinely omitted MBP , whereas another 110 patients ( PREP ) were prepared with enemas , laxatives , or both . Both groups received 24 hours of preoperative dietary restriction to clear liquids and perioperative parenteral antibiotics . The No PREP group had one anastomotic leak and no wound infections , whereas the PREP group had 2 anastomotic leaks and 1 wound infection ( P = .58 ) . These results occurred despite greater duration of antibiotic therapy and incidence of delayed wound closures in the PREP group . CONCLUSION The results of this pilot study suggest that omitting MBP before elective intestinal operations in infants and children carries no increased risk of infectious or anastomotic complications . Eliminating MBP may reduce health care costs and inconvenience to patients . These findings warrant a large , prospect i ve , r and omized clinical trial to vali date our findings and to investigate further the necessity of MBP in the pediatric population Recent studies have suggested that MBP does not lower the risk of postoperative septic complications after elective colorectal surgery . This r and omized clinical trial assessed whether preoperative MBP is beneficial in elective colonic surgery BACKGROUND Bowel preparation prior to colonic surgery usually includes antibiotic therapy together with mechanical bowel preparation ( MBP ) . Mechanical bowel preparation may cause discomfort to the patient , prolonged hospitalization , and water and electrolyte imbalance . It was assumed that with the improvement in surgical technique together with the use of more effective prophylactic antibiotics , it was possible that MBP would no longer be necessary . HYPOTHESIS There is no statistical difference in the postoperative results of patients who undergo elective colon resection with MBP  as compared with those who have no MBP . DESIGN AND PATIENTS The study includes all patients who had elective large bowel resection at Campus Golda between April 1 , 1999 , and March 31 , 2002 . Emergency operations were not included . The patients were r and omly assigned to the 2 study groups ( with or without MBP ) according to identification numbers . All patients were treated with intravenous and oral antibiotics prior to surgery . The patients in the MBP group received Soffodex for bowel preparation . RESULTS A total of 329 patients participated in the study , 165 without MBP and 164 with MBP . The 2 groups were similar in age , sex , and type of surgical procedure . Two hundred sixty-eight patients ( 81.5 % ) underwent surgery owing to colorectal cancer and 61 patients ( 18.5 % ) owing to benign disease . The hospitalization period was longer in the bowel-prepared group ( mean + /- SD , 8.2 + /- 5.1 days ) as compared with the nonprepared group ( mean + /- SD , 8.0 + /- 2.7 days ) . However , this difference was not statistically significant . The time until the first bowel movement was similar between the 2 groups : a mean + /- SD of 4.2 + /- 1.3 days in the nonprepared group as compared with a mean + /- SD of 4.3 + /- 1.1 days in the prepared group ( P = NS ) . Four patients ( 1.2 % ) died in the postoperative course owing to acute myocardial infa rct ion and pulmonary embolism . Sixty-two patients ( 37.6 % ) of the non-MBP group suffered from postoperative complications as compared with 77 patients ( 46.9 % ) of the MBP group . CONCLUSION Our results suggest that no advantage is gained by preoperative MBP in elective colorectal surgery Eight r and omized clinical trials and two meta‐analyses recently question ed the value of preoperative mechanical bowel preparation ( MBP ) in colorectal surgery . However , very few patients having rectal surgery were included in these studies . The aim of this study was to assess whether rectal cancer surgery can be performed safely without MBP Objective : To assess with a single-blinded , multicenter , r and omized trial , the postoperative results in patients undergoing sphincter-saving rectal resection for cancer without preoperative mechanical bowel preparation ( MBP ) .  Background : The collective evidence from literature strongly suggests that MBP , before elective colonic surgery , is of no benefit in terms of postoperative morbidity . Very few data and no r and omized study are available for rectal surgery and preliminary results conclude toward the safety of rectal resection without MBP . Methods : From October 2007 to January 2009 , patients scheduled for elective rectal cancer sphincter-saving resection were r and omized to receive preoperative MBP ( ie , retro grade enema and oral laxatives ) or not . Primary endpoint was the overall 30-day morbidity rate . Secondary endpoints included mortality rate , anastomotic leakage rate , major morbidity rate ( Dindo III or more ) , degree of discomfort for the patient , and hospital stay . Results : A total of 178 patients ( 103 men ) , including 89 in both groups ( no-MBP and MBP groups ) , were included in the study . The overall and infectious morbidity rates were significantly higher in no-MBP versus MBP group , 44 % versus 27 % , P = 0.018 , and 34 % versus 16 % , P = 0.005 , respectively . Regarding both anastomotic leakage and major morbidity rates , there was no significant difference between no-MBP and MBP group : 19 % versus 10 % ( P = 0.09 ) and 18 % versus 11 % ( P = 0.69 ) , respectively . Moderate or severe discomfort was reported by 40 % of prepared patients . Mortality rate ( 1.1 % vs 3.4 % ) and mean hospital stay ( 16 vs 14 days ) did not differ significantly between both groups . Conclusions : This first r and omized trial demonstrated that rectal cancer surgery without MBP was associated with higher risk of overall and infectious morbidity rates without any significant increase of anastomotic leakage rate . Thus , it suggests continuing to perform MBP before elective rectal resection for cancer . This study is registered with clinical trials.gov , number NCT00554892 PURPOSE : Efficient mechanical bowel preparation has been regarded as essential in preventing postoperative complications of colorectal surgery , but the necessity of bowel cleansing has been disputed recently . The aim of this study was to evaluate the outcome of elective colorectal surgery in patients with or without bowel preparation . METHODS : Altogether , 267 consecutive adult patients admitted for elective open colorectal surgery were r and omly assigned either to the bowel preparation group with oral polyethylene glycol electrolyte solution ( 138 patients ) or no preparation group ( 129 patients ) . Patients who were unable to drink polyethylene glycol electrolyte solution , those who had had bowel preparation within the previous week , and patients not needing opening of the bowel were excluded . Routine colorectal surgery was undertaken , and infectious and other complications were registered daily . Late complications were checked up one to two months after surgery . RESULTS : No deaths were recorded , and 76 percent of the patients in the polyethylene glycol electrolyte solution group and 81 percent in the unprepared group recovered without complication . Anastomotic leaks occurred in 4 percent of the polyethylene glycol electrolyte solution patients and in 2 percent of the other cases , and other surgical site infections occurred in 6 and 5 percent , respectively . None of the differences was statistically significant . There was no difference in restoration of bowel function . The median postoperative stay was eight days in both groups . CONCLUSIONS : Preoperative bowel preparation seems to offer no benefit in elective open colorectal surgery Background Preoperative mechanical bowel preparation can be question ed as st and ard procedure in colon surgery , based on the result from several r and omised trials . Methods As part of a large multicenter trial , 105 patients planned for elective colon surgery for cancer , adenoma , or diverticulitis in three hospitals were asked to complete a question naire regarding perceived health including experience with bowel preparation . There were 39 questions , each having 3 – 10 answer alternatives , dealing with food intake , pain , discomfort , nausea/vomiting , gas distension , anxiety , tiredness , need of assistance with bowel preparation , and willingness to undergo the procedure again if necessary . Results 60 patients received mechanical bowel preparation ( MBP ) and 45 patients did not ( No-MBP  ) . In the MBP group 52 % needed assistance with bowel preparation and 30 % would consider undergoing the same preoperative procedure again . In the No-MBP group 65 % of the patients were positive to no bowel preparation . There was no significant difference between the two groups with respect to postoperative pain and nausea . On Day 4 ( but not on Days 1 and 7 postoperatively ) patients in the No-MBP group perceived more discomfort than patients in the MBP group , p = 0.02 . Time to intake of fluid and solid food did not differ between the two groups . Bowel emptying occurred significantly earlier in the No-MBP group than in the MBP group , p = 0.03 . Conclusion Mechanical bowel preparation is distressing for the patient and associated with a prolonged time to first bowel emptying AIM In this r and omized prospect i ve clinical study , we aim ed to evaluate the effect of mechanical bowel preparation ( MBP ) before Milligan-Morgan hemorrhoidectomy on intraoperative procedures and postoperative complication rates to determine whether MBP is adventageous or not before elective anorectal surgeries . METHODS Forty patients who had internal grade III or IV hemorrhoidal disease and who would underwent open hemorrhoidectomy were r and omized into two groups : non-MBP group ( female : male , 11:9 ; mean age , 33.8±9.57 years ) that would not receive MBP before the surgery , and MBP group ( female : male , 12:8 ; mean age , 34.7±11.37 years ) that would be given one Fleet enema on the morning of Milligan-Morgan hemorrhoidectomy . Intraoperative variables and postoperative complications were compared between two groups . RESULTS MPB had no effect on both intraoperative and postoperative variables , such as operating time , intraoperative bleeding , visual analogue scale ( VAS ) score for the comfort of the surgeon during operation , the presence of stool or enema remnants in anal canal , the presence of mucosal edema of the anal canal intraoperatively , the rates of postoperative bleeding and infection , VAS score for the pain on third day postoperatively , time to first stool after the operation , VAS score for the pain during first stool after the operation , and number of analgesics during one week postoperatively ( P>0.05 for all ) . CONCLUSION MBP performed before surgery does not provide introperative or postoperative benefit for Milligan-Morgan hemorrhoidectomy , thus MBP is not necessary before elective anorectal surgeries Objective To compare mechanical bowel preparation ( MBP ) using oral magnesium citrate with sodium phosphate enema to sodium phosphate ( NaP ) enema alone during minimally invasive pelvic reconstructive surgery . Methods We conducted a single-blind , r and omized controlled trial of MBP versus NaP in women undergoing minimally invasive pelvic reconstructive surgery . The primary outcome was intraoperative quality of the surgical field . Secondary outcomes included surgeon assessment of bowel h and ling and patient-reported tolerability symptoms . Results One hundred fifty-three participants were enrolled ; 148 completed the study ( 71 MBP and 77 NaP ) . Patient demographics , clinical and intraoperative characteristics were similar . Completion of assigned bowel preparation was similar between MBP ( 97.2 % ) and NaP ( 97.4 % ) . The MBP group found the preparation more difficult ( P<0.01 ) and reported more overall discomfort and negative preoperative side effects ( all P⩽0.01 ) . Quality of surgical field at initial port placement was excellent/good in 80.0 % of the MBP group compared with 62.3 % in the NaP group ( P=0.02 ) . This difference was not maintained by the conclusion of surgery ( P=0.18 ) . Similar results were seen in the intent-to-treat population . Surgeons accurately guessed preparation 65.7 % of the time for MBP versus 41.6 % for NaP ( P=0.36 ) . At 2 weeks postoperatively , both reported a median time for return of bowel function of 3.0 ( 2.0–4.0 ) days . Conclusions Mechanical bowel preparation with oral magnesium citrate before minimally invasive pelvic reconstructive surgery offered initial improvement in the quality of surgical field , but this benefit was not sustained . It was associated with an increase in patient discomfort preoperatively , but did not seem to impact postoperative return of bowel function . LEVEL OF EVIDENCE BACKGROUND : Preoperative bowel preparation with or without oral antibiotics is controversial in terms of postoperative surgical site infections . OBJECTIVE : This study aim ed to evaluate the efficacy of oral antibiotics as adjunct therapy to systemic antibiotics with mechanical bowel preparation for preventing surgical site infections in clean contaminated , contaminated , and dirty colorectal procedures . DESIGN : This was a single-center , prospect i ve r and omized study . SETTING : This study was conducted at the General Surgery Department at Jinling Hospital , Nanjing University , China , from July 15 , 2014 to January 20 , 2016 . PATIENTS : Patients aged ≥18 years scheduled for abdominal surgery with clean-contaminated , contaminated , and dirty wounds were selected . INTERVENTIONS : Patients were r and omly assigned to receive preoperative mechanical bowel preparation or mechanical bowel preparation with oral antibiotics . MAIN OUTCOMES : The primary outcome was the rate of surgical site infections . The secondary outcomes were extra-abdominal complications , duration of postoperative ileus , and readmission rate . RESULTS : Ninety-five patients were allocated to each group . Eight and 26 surgical site infections ( 8.42 % vs 27.3 % , p = 0.004 ) occurred in the mechanical bowel preparation with oral antibiotics and mechanical bowel preparation groups . Thirteen extra-abdominal complications were reported : 6 in the mechanical bowel preparation with oral antibiotics group and 7 in the mechanical bowel preparation group ( 6.3 % vs 7.3 % , p = 0.77 ) . Postoperative ileus duration did not differ between groups ( p = 0.23 ) . There were 4 readmissions in the mechanical bowel preparation group and none in the mechanical bowel preparation with oral antibiotics group ( p = 0.04 ) . On multivariable analysis , blood loss ≥500 mL ( OR , 5.1 ; 95 % CI , 1.27–20.4 ; p = 0.02 ) , ASA score ≥3 ( OR , 3.9 ; 95 % CI , 1.2–12.5 ; p = 0.01 ) , contaminated types ( OR , 3.6 ; 95 % CI , 1.5–8.6 ; p = 0.01 ) , and administration of preoperative oral antibiotics ( OR , 0.20 ; 95 % CI , 0.06–0.60 ; p = 0.005 ) independently affected the incidence of surgical site infections . LIMITATIONS : This was a single-center study . CONCLUSION : Preoperative oral antibiotics , as adjunct therapy to systemic antibiotics and mechanical bowel preparation , significantly reduced surgical site infections and minimized the readmission rates in clean contaminated , contaminated , and dirty  types of colorectal surgery .  See Video Abstract at http://links.lww.com/DCR/A437 Aim : Postoperative ileus is an important factor of complications following gastrointestinal procedures . Its pathophysiology and the parameters , which may impact on its duration , remain unclear . The aim of this study was to measure the role of various clinical determinants on restoration of intestinal function after  elective colorectal surgery .  Methods : From July 2002 to September 2003 , all patients who underwent laparotomy for colectomy ( laparoscopic resections excluded ) with either an ileotransverse , colocolic , or high colorectal anastomosis  were entered in this prospect i ve study . The intervals in hours between the end of the surgical procedure and passing of flatus ( PG ) and passing of stool ( PS ) were recorded by an independent investigator . PG and PS were eventually correlated with the following parameters : type of colectomy , early removal of nasogastric tube ( NGT ) , mechanical bowel preparation ( MBP ) , type of underlying disease , systemic administration of opiates , and surgical training ( colorectal fellowship or other ) . Results : One hundred twenty-four patients were entered in this study . Four patients ( 3.2 % ) developed septic complications ( 3 anastomotic leaks and 1 intraabdominal abscess ) and were excluded from the analysis . Median age in this population was 68 ( range 30–95 ) years .  Mean duration of postoperative ileus was 70±28 h ( PG ) and 99±34 h ( PS ) . The type of colectomy , underlying disease , MBP , and early NGT removal failed , in univariate analysis , to correlate with the duration of postoperative ileus . By contrast , time intervals PG and PS were statistically shorter in the group of patients treated by a colorectal surgeon [ 56±23 vs 74±28 h ( PG ) ; 82±26 vs 103±35 h ( PS ) , p=0.004 ] , as well as in patients who received systemic opiates for less than 2 days [ 64±27 vs 75±28 h ( PG ) , p=0.04 ; 88±32 vs 108±33 h ( PS ) , p=001 ] . Conclusion : Restoration of normal intestinal function after elective open colectomy takes 3 ( PG ) to 4 ( PS ) days . In our series , specialized training in colorectal surgery has a positive impact on the duration of postoperative ileus . Surgical specialization should be considered an important parameter in future clinical trials aim ing to minimize postoperative ileus In a prospect i ve , r and omized double-blind trial , the efficacy of whole gut irrigation as preoperative bowel preparation for elective colorectal surgery was evaluated alone and in combination with two antimicrobial agents in 148 patients . The antimicrobial regimens were metronidazole alone or metronidazole and ampicillin administered systemically preoperatively and continued for 3 days . Whole gut irrigation was completed without any discomfort in 87 percent of the patients . In 3 percent , the irrigation was stopped and the patients were excluded from the study . Abdominal wound infection developed in 32 percent of the patients after whole gut irrigation , and the addition of metronidazole decreased this incidence to 22 percent ( not significant ) . The incidence in wound infections in the group receiving metronidazole as well as ampicillin was 2 percent , and this difference was highly significant compared with both other groups . No significant difference was found for the incidence of intraabdominal abscesses ( p = 0.06 ) , infection of the perineal wound , or anastomotic leakage . No difference in the postoperative infection rate was found between a bowel containing fecal fluid or fecal masses , but when a bowel was clean , significantly fewer infectious complications were found . Whole gut irrigation is a rapid , well-tolerated , easily performed , and safe form of preoperative bowel preparation in elective colorectal surgery if combined with systemic antimicrobial prophylaxis consisting of antimicrobial agents effective against anaerobic and aerobic organisms BACKGROUND Guidelines regarding bowel preparation exist for the adult but not the pediatric population . Our aim was to evaluate the bowel preparation practice s , including antibiotic usage for elective colorectal operations in children . METHODS A survey was design ed and administered to a nationwide group of pediatric surgeons to ascertain current practice s of bowel preparation . RESULTS Four hundred ninety-three surveys were administered , and 136 physicians responded ( 28 % ) .  Mechanical bowel preparation was used by 96 % of the respondents . Preoperative  intravenous antibiotics  were used by 99 % of respondents . The number of years in practice did not significantly affect the use of oral antibiotics  ( P = .62 ) or the duration of intravenous antibiotics  ( P = .78 ) . CONCLUSIONS There is a wide variation in bowel preparation practice s in children . A prospect i ve , r and omized trial would be helpful to identify the role of oral antibiotics and optimal duration of intravenous antibiotics in this population A r and omized prospect i ve study was conducted on 194 patients who underwent elective colorectal surgery for carcinoma . All patients received the same mechanical bowel preparation . In addition , patients in group A received oral neomycin and erythromycin base ; patients in group B received systemic metronidazole and gentamicin , while patients in group C received both oral and systemic antibiotics .  Postoperative septic complications related to colorectal surgery occurred in 27.4 per cent , 11.9 per cent and 12.3 per cent respectively in groups A , B and C ( X2 = 7 ; P < 0.05 ) . The incidence of sepsis in groups B and C was almost identical . Patients who received oral antibiotics alone ( group A ) had significantly higher risks of postoperative sepsis when compared with patients in either group B or group C ( P < 0.05 ) . As there is no additional advantage of combining oral and systemic antibiotics , we recommend systemic metronidazole and gentamicin to be used with mechanical bowel preparation in elective colorectal surgery BACKGROUND Surgical site infections ( SSI ) are a common complication after colorectal surgery . An infection prevention bundle ( IPB ) was implemented to improve outcomes . STUDY DESIGN A st and ardized IPB that included the administration of oral antibiotics with a mechanical bowel preparation , preoperative shower with chlorhexidine , hair removal and skin preparation in holding , antibiotic wound irrigation , and a " clean-closure " protocol was implemented in January 2013 . Data from the American College of Surgeons NSQIP were analyzed at a single academic institution to compare pre-IPB and post-IPB SSI rates . In January 2014 , a prospect i ve data base was implemented to determine compliance with individual IPB elements and their effect on outcomes . RESULTS For the 24 months pre-IPB , the overall SSI rate was 19.7 % . During the 30 months after IPB implementation , the SSI rate decreased to 8.2 % ( p < 0.0001 ) . A subset of 307 patients was identified in both NSQIP and our prospect i ve compliance data bases . Elements of IPB associated with decreased SSI rates included preoperative shower with chlorhexidine ( 4.6 % vs 16.2 % ; p = 0.005 ) , oral antibiotics ( 3.4 % vs 15.4 % ; p < 0.001 ) , and mechanical bowel preparation ( 4.4 % vs 14.3 % ; p = 0.008 ) . Patients who received a full bowel preparation of both oral antibiotics and a mechanical bowel preparation had a 2.7 % SSI rate compared with 15.8 % for all others ( p < 0.001 ) . On multivariate analysis , full bowel preparation was independently associated with significantly fewer SSI ( adjusted odds ratio 0.2 ; 95 % CI 0.1 to 0.9 ; p = 0.006 ) . CONCLUSIONS Implementation of an IPB was successful in decreasing SSI rates in colorectal surgery patients . The combination of oral antibiotics with a mechanical bowel preparation was the strongest predictor of decreased SSI Background : Colorectal surgeries frequently require bowel preparation . In children , ( is this st and ard of care ? : this method is mostly followed ) this is usually performed using normal saline , which is very cumbersome and causes unnecessary discomfort . This study compared polyethylene glycol ( PEG ) with normal saline for preoperative bowel preparation in children . Patients and Methods : Thirty patients , admitted in the Department of Paediatric Surgery , Rajindra Hospital , Patiala , for colonic and colorectal surgical procedures , were divided into two groups , I ( PEG ) and II ( NS ) , r and omly for bowel preparation with PEG and normal saline , respectively . Results : It was found that there was no significant difference in the quality of preparation ( P > 0.05 ) , but PEG use was found to be easier , more comfortable and acceptable for the patients , their relatives and the hospital staff . Overall , complications are significantly lesser for PEG preparation ( P < 0.05 ) . There was no significant difference in the overall cost . Conclusion : Thus , it can be inferred that PEG may be a safe , cost-effective and acceptable option for large bowel preparation STUDY OBJECTIVE To study the application of a fast-track care protocol in colorectal surgery for deep infiltrating endometriosis . Bowel endometriosis is an infrequent but not rare condition that often needs intestinal surgery and imposes a high economic burden on society . DESIGN Prospect i ve r and omized trial ( Canadian Task Force classification I ) . SETTING Tertiary referral center . PATIENTS Two hundred twenty-seven patients with preoperative evidence of bowel endometriosis . INTERVENTIONS We r and omly assigned 227 patients with preoperative evidence of bowel endometriosis to a fast-track protocol ( no preoperative bowel preparation , early restoration of diet , no postoperative antibiotics , and early postoperative mobilization ) or conventional care for laparoscopic intestinal surgery . R and omization was obtained on a double-blind , date -based schedule , and all procedures were performed by a homogenous group of expert surgeons . Surgical outcomes and a health economic evaluation were assessed . MEASUREMENTS AND MAIN RESULTS The primary outcome was hospital stay . Patient 's well-being and intraoperative and postoperative complications up to 30 days after surgery were also assessed . Subsequently , direct medical costs were analyzed . Patients assigned to the fast-track protocol were discharged earlier ( median 3 vs 7 days , p < .001 ) with no significant differences in subjective well-being ( p = .55 ) . Operative details , postoperative complications , and need of temporary ileostomy were similar ( p = .89 ) between groups as well as readmission rates within 30 days ( p = .69 ) . The application of a fast-track protocol result ed in an overall significant reduction of costs ( USD 6699 vs 8674 , p < .01 ) , and differences were more evident in cases of protective stoma ( 7652 vs 8793 , p < .05 ) and surgery with postoperative complications ( 10 835 vs 14 005 , p < .01 ) . CONCLUSION The application of a fast-track care protocol for laparoscopy in cases of pelvic and intestinal endometriosis does not increase the risk of complications and ensures a reduction of medical costs To determine whether mechanical bowel preparation influences the incidence of anastomotic dehiscence following colorectal surgery , 186 patients undergoing elective left colonic or rectal resection were r and omized before surgery to bowel preparation ( n = 89 ) or no bowel preparation ( n = 97 ) . Surgical technique was st and ardized and no patient had a defunctioning colostomy . Seventeen patients were excluded ( seven with preparation , ten without ) . Indications for surgery in the remaining 169 patients were carcinoma ( 133 patients ) , diverticular disease ( 26 ) , inflammatory bowel disease ( six ) and miscellaneous conditions ( four ) . Operations performed were left colonic resection or reversal of Hartmann 's procedure ( 26 with preparation , 28 without ) and anterior resection ( 56 versus 59 ) . The overall morbidity rate ( 18 per cent ) was similar in the two groups . All seven clinical anastomotic leaks occurred after low anterior resection , in three of the 39 patients who had undergone bowel preparation and four of the 36 who had not ( P>0·9 ) . Two deaths occurred , both of patients who had received bowel preparation , one being secondary to anastomotic leakage .  Bowel preparation does not influence outcome after elective colorectal surgery The impact on wound infection of the addition of perioperative cefam and ole to a mechanical bowel preparation with oral antibiotics was studied in a prospect i ve r and omized series of patients undergoing elective colectomy for biopsy-proven carcinoma or adenomatous polyps . Seventy patients were r and omized , all underwent mechanical bowel preparation and received oral neomycin and erythromycin base .  Thirty-four patients also received a preoperative and four postoperative doses of cefam and ole , while 36 patients were r and omized to receive no parenteral antibiotics . The two groups were well stratified for age , sex , and risk factors . The Dukes stage was similar and the surgical procedures were equally distributed in the two groups . There were no wound infections in the 34 patients receiving cefam and ole and only one wound infection ( 2.8 percent ) in the 36 control patients . Therefore , the addition of perioperative intravenous cefam and ole to a good mechanical bowel preparation with oral antibiotics was of no benefit in reducing wound infections following resection of colorectal malignancies in this select group of patients
Conclusion Based on the current literature , there is insufficient evidence to indicate that the use of MBP leads to a significant difference in the risk of developing infectious complications in pediatric colorectal surgery
Objectives To evaluate whether the application of mechanical bowel preparation ( MBP ) before colorectal surgery reduces the risk of developing infectious complications in children .