Preparation: Is It Necessary?

Question 1

Overall objective for the use of bowel preparation in colorectal surgery is to reduce postoperative complications:

Answer 1

1. Decrease the rate of surgical site infections (SSIs)
2. Decrease anastomotic leak rates
3. Alter gut microbiome

Question 2

A bowel preparation accomplishes these goals via two mechanisms:

Answer 2

-Evacuation of fecal material from the colon
-Eradication of stool bacterial load.

Question 3

Two types of MBPs

Answer 3

hyperosmotic versus isosmotic

Question 4

Hyperosmotic MBPs (e.g., magnesium citrate, sodium phosphate)

Answer 4

> osmotic effect, drawing fluid into the bowel lumen, as a mechanism of flushing out colonic contents

> cause electrolyte and fluid imbalances and dehydration. > may Cause acute kidney injury

Question 5

Contraindications to hyperosmotic solutions

Answer 5

renal failure
acute coronary syndrome
congestive heart failure
bowel obstruction
ileus
intestinal malabsorption
ascites

Question 6

ERAS consensus guidelines recommend the utilization of

Answer 6

isosmotic MBPs > osmotically balanced, nonabsorbable solution

> do not produce significant fluid or electrolyte shifts.
safe in patients with the comorbidities of hepatic disease, congestive heart failure, and renal failure.

Question 7

First-line antibiotics for chemical preparation

Answer 7

combination of oral neomycin sulfate plus oral erythromycin base

or

oral neomycin sulfate plus oral metronidazole

Question 8

OA alone is associated with

Answer 8

similar SSI rates to OA plus MBP

lower SSI rates as compared with both MBP alone and no bowel preparation.

Question 9

how much decrease in ssi

Answer 9

OA alone > 67% decrease in SSI rate

OA  +  MBP > 57% decrease in SSI rate

Question 10

Rt and Lt Colon

Answer 10

right colon bacterial concentrations range from 106 to 107 bacteria/ g of stool content

numbers rise to 1011 to 1012 bacteria/ g in the rectosigmoid.

lower risk of SSIs after right colectomies versus left colectomies or rectal resections.

patients undergoing right-sided versus left-sided colectomies/ proctectomies show a preventative function of OAs in left-sided colectomies/ proctectomies

Question 11

ERAS guidelines

Answer 11

-Routine use of combined isosmotic MBP with OA before elective colorectal surgery
-Oral carbohydrate loading to MBP,
-Intake of clear liquids up to 2 hours before surgery

> better tolerate adverse side effects of MBP while also requiring less fluid administration intraoperatively.