Outcome of Anastomotic Leakage after Colorectal Surgery in Patients with or without Preoperative Mechanical Bowel Irrigation: An Observational Study

Background: Randomized controlled trials have demonstrated that the rate of anastomotic leakage after laparoscopic colorectal surgery does not differ between patients with or without preoperative bowel preparation. There is, however, still an ongoing discussion that infectious complications consequential to anastomotic leakage, in particular sepsis, are more severe in patients without preoperative bowel cleaning. The aim of this study is to evaluate the assumption that postoperative sepsis in patients undergoing colorectal surgery without mechanical preoperative bowel irrigation is more severe compared to patients with bowel preparation. Methods: In the surgical unit in a teaching hospital in Zurich patients undergoing laparoscopic colorectal surgery were consecutively included in the study. 367 patients with colorectal surgery between December 2000 and April 2004 underwent preoperative mechanical bowel irrigation. From May 2004 until April 2008 colorectal surgery was performed in 367 patients without bowel irrigation. Outcomes of interest are: Severity of sepsis in patients with postoperative anastomotic leakage, assessed by the necessity of referral to ICU, length of stay in the ICU and total length of hospital stay. Results: 734 patients were included in the study, 367 patients with and 367 without preoperative bowel preparation. In 43 patients an anastomotic insufficiency was diagnosed, 26 in the group with and in 17 patients without preoperative irrigation. 14 of these cases developed sepsis and were referred to ICU, 8 (31%) in the group with and 6 (35%) in the group without preparative irrigation. Between the two groups there were no significant differences in mortality, length of stay on ICU and total length of hospital stay. Conclusions: The results of our study provide no indication that the course of sepsis, associated with anastomotic leakage after laparoscopic colorectal surgery, is more severe in patients without preoperative bowel preparation, compared to those with bowel cleaning.