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Effectiveness of mechanical bowel preparation versus no preparation on anastomotic leakage in colorectal surgery: a systematic review and meta-analysis

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Title: Effectiveness of mechanical bowel preparation versus no preparation on anastomotic leakage in colorectal surgery: a systematic review and meta-analysis
Authors: Leenen, Jobbe P.L., Hentzen, Judith E.K.R., Ockhuijsen, Henrietta D.L., Leiding Zorg VPG/Gynaecologie, Other research (not in main researchprogram)
Publication Year: 2019
Subject Terms: Anastomotic leaks, Colorectal surgery, Mechanical bowel preparation, Oncology, Systematic review, Postoperative Complications/prevention & control, Humans, Middle Aged, Colorectal Surgery/methods, Digestive System Surgical Procedures/methods, Male, Anastomotic Leak/prevention & control, Enema/methods, Cathartics/administration & dosage, Randomized Controlled Trials as Topic, Colorectal Neoplasms/surgery, Preoperative Care/methods, Adult, Female, Aged, Databases, Bibliographic, Taverne, Surgery, Meta-Analysis, Journal Article
Description: It has been a standard practice to perform mechanical bowel preparation (MBP) prior to colorectal surgery to reduce the risk of colorectal anastomotic leakages (CAL). The latest Cochrane systematic review suggests there is no benefit for MBP in terms of decreasing CAL, but new studies have been published. The aim of this systematic review and meta-analysis is to update current evidence for the effectiveness of preoperative MBP on CAL in patients undergoing colorectal surgery. Consequently, PubMed, MEDLINE, Embase, CENTRAL and CINAHL were searched from 2010 to March 2017 for randomised controlled trials (RCT) that compared the effects of MBP in colorectal surgery on anastomotic leakages. The outcome CAL was expressed in odds ratios and analysed with a fixed-effects analysis in a meta-analysis. Quality assessment was performed by the cochrane risk of bias tool and grades of recommendation, assessment, development and evaluation (GRADE) methodology. Eight studies (1065 patients) were included. The pooled odds ratio showed no significant difference of MBP in colorectal surgery on CAL (odds ratio (OR) = 1.15, 95% CI = 0.68–1.94). According to GRADE methodology, the quality of the evidence was low. To conclude, MBP for colorectal surgery does not lower the risk of CAL. These results should, however, be interpreted with caution due to the small sample sizes and poor quality. Moreover, the usefulness of MBP in rectal surgery is not clear due to the lack of stratification in many studies. Future research should focus on high-quality, adequately powered RCTs in elective rectal surgery to determine the possible effects of MBP.
Document Type: article in journal/newspaper
File Description: text/plain
Language: English
ISSN: 2038-131X
Relation: https://dspace.library.uu.nl/handle/1874/394253
Availability: https://dspace.library.uu.nl/handle/1874/394253
Rights: info:eu-repo/semantics/OpenAccess
Accession Number: edsbas.41C4D86D
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  Data: Effectiveness of mechanical bowel preparation versus no preparation on anastomotic leakage in colorectal surgery: a systematic review and meta-analysis
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  Data: <searchLink fieldCode="AR" term="%22Leenen%2C+Jobbe+P%2EL%2E%22">Leenen, Jobbe P.L.</searchLink><br /><searchLink fieldCode="AR" term="%22Hentzen%2C+Judith+E%2EK%2ER%2E%22">Hentzen, Judith E.K.R.</searchLink><br /><searchLink fieldCode="AR" term="%22Ockhuijsen%2C+Henrietta+D%2EL%2E%22">Ockhuijsen, Henrietta D.L.</searchLink><br /><searchLink fieldCode="AR" term="%22Leiding+Zorg+VPG%2FGynaecologie%22">Leiding Zorg VPG/Gynaecologie</searchLink><br /><searchLink fieldCode="AR" term="%22Other+research+%28not+in+main+researchprogram%29%22">Other research (not in main researchprogram)</searchLink>
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  Data: 2019
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  Data: <searchLink fieldCode="DE" term="%22Anastomotic+leaks%22">Anastomotic leaks</searchLink><br /><searchLink fieldCode="DE" term="%22Colorectal+surgery%22">Colorectal surgery</searchLink><br /><searchLink fieldCode="DE" term="%22Mechanical+bowel+preparation%22">Mechanical bowel preparation</searchLink><br /><searchLink fieldCode="DE" term="%22Oncology%22">Oncology</searchLink><br /><searchLink fieldCode="DE" term="%22Systematic+review%22">Systematic review</searchLink><br /><searchLink fieldCode="DE" term="%22Postoperative+Complications%2Fprevention+%26+control%22">Postoperative Complications/prevention & control</searchLink><br /><searchLink fieldCode="DE" term="%22Humans%22">Humans</searchLink><br /><searchLink fieldCode="DE" term="%22Middle+Aged%22">Middle Aged</searchLink><br /><searchLink fieldCode="DE" term="%22Colorectal+Surgery%2Fmethods%22">Colorectal Surgery/methods</searchLink><br /><searchLink fieldCode="DE" term="%22Digestive+System+Surgical+Procedures%2Fmethods%22">Digestive System Surgical Procedures/methods</searchLink><br /><searchLink fieldCode="DE" term="%22Male%22">Male</searchLink><br /><searchLink fieldCode="DE" term="%22Anastomotic+Leak%2Fprevention+%26+control%22">Anastomotic Leak/prevention & control</searchLink><br /><searchLink fieldCode="DE" term="%22Enema%2Fmethods%22">Enema/methods</searchLink><br /><searchLink fieldCode="DE" term="%22Cathartics%2Fadministration+%26+dosage%22">Cathartics/administration & dosage</searchLink><br /><searchLink fieldCode="DE" term="%22Randomized+Controlled+Trials+as+Topic%22">Randomized Controlled Trials as Topic</searchLink><br /><searchLink fieldCode="DE" term="%22Colorectal+Neoplasms%2Fsurgery%22">Colorectal Neoplasms/surgery</searchLink><br /><searchLink fieldCode="DE" term="%22Preoperative+Care%2Fmethods%22">Preoperative Care/methods</searchLink><br /><searchLink fieldCode="DE" term="%22Adult%22">Adult</searchLink><br /><searchLink fieldCode="DE" term="%22Female%22">Female</searchLink><br /><searchLink fieldCode="DE" term="%22Aged%22">Aged</searchLink><br /><searchLink fieldCode="DE" term="%22Databases%22">Databases</searchLink><br /><searchLink fieldCode="DE" term="%22Bibliographic%22">Bibliographic</searchLink><br /><searchLink fieldCode="DE" term="%22Taverne%22">Taverne</searchLink><br /><searchLink fieldCode="DE" term="%22Surgery%22">Surgery</searchLink><br /><searchLink fieldCode="DE" term="%22Meta-Analysis%22">Meta-Analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Journal+Article%22">Journal Article</searchLink>
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  Label: Description
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  Data: It has been a standard practice to perform mechanical bowel preparation (MBP) prior to colorectal surgery to reduce the risk of colorectal anastomotic leakages (CAL). The latest Cochrane systematic review suggests there is no benefit for MBP in terms of decreasing CAL, but new studies have been published. The aim of this systematic review and meta-analysis is to update current evidence for the effectiveness of preoperative MBP on CAL in patients undergoing colorectal surgery. Consequently, PubMed, MEDLINE, Embase, CENTRAL and CINAHL were searched from 2010 to March 2017 for randomised controlled trials (RCT) that compared the effects of MBP in colorectal surgery on anastomotic leakages. The outcome CAL was expressed in odds ratios and analysed with a fixed-effects analysis in a meta-analysis. Quality assessment was performed by the cochrane risk of bias tool and grades of recommendation, assessment, development and evaluation (GRADE) methodology. Eight studies (1065 patients) were included. The pooled odds ratio showed no significant difference of MBP in colorectal surgery on CAL (odds ratio (OR) = 1.15, 95% CI = 0.68–1.94). According to GRADE methodology, the quality of the evidence was low. To conclude, MBP for colorectal surgery does not lower the risk of CAL. These results should, however, be interpreted with caution due to the small sample sizes and poor quality. Moreover, the usefulness of MBP in rectal surgery is not clear due to the lack of stratification in many studies. Future research should focus on high-quality, adequately powered RCTs in elective rectal surgery to determine the possible effects of MBP.
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RecordInfo BibRecord:
  BibEntity:
    Languages:
      – Text: English
    Subjects:
      – SubjectFull: Anastomotic leaks
        Type: general
      – SubjectFull: Colorectal surgery
        Type: general
      – SubjectFull: Mechanical bowel preparation
        Type: general
      – SubjectFull: Oncology
        Type: general
      – SubjectFull: Systematic review
        Type: general
      – SubjectFull: Postoperative Complications/prevention & control
        Type: general
      – SubjectFull: Humans
        Type: general
      – SubjectFull: Middle Aged
        Type: general
      – SubjectFull: Colorectal Surgery/methods
        Type: general
      – SubjectFull: Digestive System Surgical Procedures/methods
        Type: general
      – SubjectFull: Male
        Type: general
      – SubjectFull: Anastomotic Leak/prevention & control
        Type: general
      – SubjectFull: Enema/methods
        Type: general
      – SubjectFull: Cathartics/administration & dosage
        Type: general
      – SubjectFull: Randomized Controlled Trials as Topic
        Type: general
      – SubjectFull: Colorectal Neoplasms/surgery
        Type: general
      – SubjectFull: Preoperative Care/methods
        Type: general
      – SubjectFull: Adult
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      – SubjectFull: Female
        Type: general
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      – SubjectFull: Taverne
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      – SubjectFull: Surgery
        Type: general
      – SubjectFull: Meta-Analysis
        Type: general
      – SubjectFull: Journal Article
        Type: general
    Titles:
      – TitleFull: Effectiveness of mechanical bowel preparation versus no preparation on anastomotic leakage in colorectal surgery: a systematic review and meta-analysis
        Type: main
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            NameFull: Ockhuijsen, Henrietta D.L.
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              Type: published
              Y: 2019
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