WUTH publication: Preoperative Mechanical and Oral Antibiotic Bowel Preparation to Reduce Infectious Complications of Colorectal Surgery - The Need for Updated Guidelines

Citation: The Journal of Hospital Infection. 2019, 101(3), 295-299. Epub 2018 Dec 21
Author: Battersby CLF, Battersby NJ, Slade DAJ, Soop M, Walsh CJ
Abstract: Association of mechanical bowel preparation with oral antibiotics and anastomotic leak following left sided; colorectal resection: an international, multi-centre, prospective audit.
BACKGROUND: Increasing evidence indicates that combined mechanical and oral antibiotic bowel preparation reduces the infectious complications of colorectal surgery. Anecdotal evidence suggests the combination is rarely used in the UK & Europe.
AIM: To establish colorectal surgeons' current use, and awareness of the benefits of such bowel preparation amongst, and to identify decision-making influences surrounding preoperative bowel preparation.
METHOD: An electronic survey was emailed to all members of the Association of Coloproctology of Great Britain and Ireland, and promoted via Twitter.
FINDINGS: 495 respondents completed the survey: 413 (83.2%) UK, 39 (7.9%) other European, 43 (8.7%) non-European. Respondents used oral antibiotics for 12%-20% of cases. Mechanical bowel preparation (MBP), phosphate enema, and no preparation respectively ranged between 9%-80%. Combined MBP and oral antibiotic bowel preparation ranged between 5.5%-18.6%. 53% (260/495) agreed that combined mechanical and oral antibiotic bowel preparation reduces surgical site infection. 32% (157/495) agreed that the combination reduces risk of anastomotic leak. Kappa statistics between 0.06-0.27 indicate considerable incongruity between surgeons' awareness of the literature, and day-to-day practice. 24% (96/495) believed MBP to be incompatible with ERAS. 41% (204/495) believe that MBP delays return to normal intestinal function.
CONCLUSIONS: Few UK and European colorectal surgeons use mechanical and oral antibiotic bowel preparation, despite evidence of its efficacy in reducing infectious complications. The influence of ERAS pathways and UK and European guidelines may explain this. In contradiction to the UK and Europe, North American guidelines recommend incorporating MBP/OAB, into ERAS programmes. We suggest future UK and European guidelines incorporate MBP/OABP into the ERAS pathway.
Copyright © 2018 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

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WUTH publication: The Association of Coloproctology of Great Britain and Ireland consensus guidelines in surgery for inflammatory bowel disease

Citation: Colorectal Disease. 2018, 20(Sup 8), 3-117
Author: Brown SR, Fearnhead NS, Faiz OD, Abercrombie JF, Acheson AG, Arnott RG, Clark SK, Clifford S, Davies RJ, Davies MM, Douie WJP, Dunlop MG, Epstein JC, Evans MD, George BD, Guy RJ, Hargest R, Hawthorne AB, Hill J, Hughes GW, Limdi JK, Maxwell-Armstrong CA, O'Connell PR, Pinkney TD, Pipe J, Sagar PM, Singh B, Soop M, Terry H, Torkington J, Verjee A, Walsh CJ, Warusavitarne JH, Williams AB, Williams GL, Wilson RG, ACPGBI IBD Surgery Consensus Collaboration
Abstract: AIM: There is a requirement of an expansive and up to date review of surgical management of inflammatory bowel disease (IBD) that can dovetail with the medical guidelines produced by the British Society of Gastroenterology.
METHODS: Surgeons who are members of the ACPGBI with a recognised interest in IBD were invited to contribute various sections of the guidelines. They were directed to produce a procedure based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. An editorial board was convened to ensure consistency of style, presentation and quality. Each author was asked to provide a set of recommendations which were evidence based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after 2 votes were included in the guidelines.
RESULTS: All aspects of surgical care for IBD have been included along with 157 recommendations for management.
CONCLUSION: These guidelines provide an up to date and evidence based summary of the current surgical knowledge in the management of IBD and will serve as a useful practical text for clinicians performing this type of surgery.
© 2018 Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.
KEYWORDS: Crohn's disease; Inflammatory bowel disease; clinical guideline; consensus; surgery; ulcerative colitis

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