AbstractsMedical & Health Science

The State of Mechanical Bowel Preparation in Colorectal Surgery

by H.P. van 't Sant (Hans Pieter)

Institution: Erasmus University
Year: 2014
Keywords: colorectal surgery; rectal cancer; colorectal resections; anastomotic leakage
Record ID: 1241996
Full text PDF: http://hdl.handle.net/1765/77144


abstract__Abstract__ Surgical resection is the cornerstone of treatment for patients with colorectal cancer and has an important role in patients with inflammatory bowel disease or other benign bowel conditions requiring surgical treatment. Generally, restoration of bowel continuity with a primary anastomosis is pursued in uncomplicated colorectal resections. The most serious complication of colorectal surgery with restoration of bowel continuity is anastomotic leakage. When the abdominal cavity is exposed to faeces due to anastomotic leakage it causes peritonitis with possible sepsis, need for reintervention and increased morbidity and mortality. The incidence of anastomotic leakage after colon surgery varies in literature between 3 and 6.4%. [1] There is a particularly high incidence following low colorectal and coloanal anastomosis accompanied by high morbidity and mortality rates ranging from 6 to 22%. Several other risk factors such as male sex, higher American Society of Anesthesiologists (ASA), intraoperative bloodloss, type of anastomosis (side-to-end vs. end-to-end) are associated with significantly higher anastomotic leakage rates in multivariate analysis. However the cause of anastomotic leakage is probably often multifactorial and many more risk factors have been identified such as obesity, diabetes, corticosteroids, preoperative pelvic irradiation, surgical experience, malnutrition, operative time etc. The application of a defunctioning ileostoma decreases the rate of symptomatic anastomotic leakage and is recommended after low anterior resection in literature. By diverting the faecal stream and keeping the anastomosis free and clean of faecal contamination, anastomotic leakage rate is reduced and in case of anastomotic leakage may cause less or milder septic complications.markdown