Abstract
Background
The aim of this study was to assess the use of mechanical bowel preparation (MBP) and antimicrobial prophylaxis in elective colorectal surgery in Switzerland.
Methods
Ninety-eight heads of surgical departments in Switzerland and 42 visceral surgeons in private practice were asked to answer an 18-item questionnaire in October 2008 about arguments in favor of or against MBP. The participants also indicated whether they use MBP and antimicrobial prophylaxis in colorectal surgery, and if so, what agents were used. Of the participants, 117/140 (83%) responded. Additional data were collected pertaining to the respondents' experience and work situation.
Results
MBP was used significantly more often for rectal surgery than for left colonic resections (83% vs. 53%; p < 0.001) and more often for left than for right colonic resections (53% vs. 43%; p = 0.001), regardless of the open or laparoscopic approach. Younger surgeons and surgeons with a higher case load in colorectal surgery used MBP significantly less frequently in open right colonic resections. For MBP, cathartics were used in 90% of patients, and enemas were used in 10% of patients. Of the respondents, 37% considered MBP to be useful, even very useful. Based on the literature, because of introduction of fast-track protocols or for considerations of patient comfort, 86% of the respondents had changed the bowel preparation regime during the last 10 years in terms of a reduction of the quantity of cathartics or restricted the indications for MBP. Antimicrobial prophylaxis was used by 100% of the respondents, 88% used a single prophylactic dose only, while 70% administered the antibiotics 30–59 min before the incision. Most of the surgeons used second-generation cephalosporins in combination with metronidazole, and 24% changed the antibiotic agent or reduced the duration of administration of antibiotics during the last 10 years.
Conclusions
MBP is often used in open and laparoscopic rectal surgery, but not in right colonic resections. Scientific evidence regarding MBP has yielded a rethinking about rigorous bowel preparation regimes. As of now, surgeons in Switzerland are not yet unanimously ready to abandon MBP in elective colorectal surgery. In Switzerland, surgeons are influenced by the benefit of antimicrobial prophylaxis in colorectal surgery.
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Acknowledgments
The authors thank the surgeons who participated in this study for their valuable information, Raffaele Galli, M.D., Lucerne, Switzerland, for his aid in translation of the questionnaire; Phillip Hendrickson, Ph.D., Basel, Switzerland and Ulrich Guller, M.D. MHS, Bern, Switzerland, for critical reading; and Ulrich Stefenelli (Services-in-statistics, Wurzburg, Germany) for scientific support.
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Authors' contributions
AB, GG, and MOG participated in the study concept and design, and they coordinated and helped to draft the manuscript and discuss the results. AB, CA, RP and MVF analyzed the data and critically revised the manuscript for important intellectual content. AB, GG and MVF obtained administrative, technical and material support. MVF has supervised the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors read and approved the final manuscript.
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Oral presentation at the 96th Meeting of the Swiss Surgical Society, June 2009, Montreux, Switzerland and at the Annual Meeting of the Swiss Society of Gastroenterology and the Swiss Society for Visceral Surgery, September 2009, Zurich, Switzerland
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Businger, A., Grunder, G., Guenin, MO. et al. Mechanical bowel preparation and antimicrobial prophylaxis in elective colorectal surgery in Switzerland—a survey. Langenbecks Arch Surg 396, 107–113 (2011). https://doi.org/10.1007/s00423-010-0718-y
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DOI: https://doi.org/10.1007/s00423-010-0718-y