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Pre-operative mechanical bowel preparation verses no-prep for pediatric patients undergoing elective colorectal surgery: a protocol to change?
Ubaidullah khan 1, sayed salah ud din 2, abdullah farooq 2, majid khan 2, Abdul hameed 2, İftikhar ahmed 2
1 Lady reading hospital/Farooq hospital Islamabad
2 lady reading hospital
Purpose: The goal of this review is to evaluate whether no mechanical bowel preparation (MBP) before colorectal surgery increases the risk of developing infectious complications in children.
Methods: We collect data for all patients for the last 3 years (January 2021-january 2024 ) who underwent surgery for Anorectal malformation (ARM), Hirschsprung disease (HD) and Re-do procedures for ARM/HD. Patients were divided into two groups, primary definitive procedure or definitive procedure with a stoma already in place. We identified all parameters which have effects on functional outcome.
Results: Total 367 patients, ARM 181, HD 143 and redo 43. Complications in both groups where low: local wound infection leading to minor wound dehiscence which was manage conservatively in 4 ARM patients and two diversion in primary HD case due to leak. There was no difference in stricture rate between those operated on with or without a stoma. At follow-up, the prevalence of soiling and constipation were similar after one-stage and multi-stage repair.
We do routine on table rectal washout for all primary HD and redo HD cases, also routine rectal washout were performed at home by mother. No mechanical bowel preparation in the hospital for any HD patients.
We do not perform any mechanical bowel preparation for ARM cases especially the primary repair of vestibular fistula cases either on operation table or preoperatively.
Feeding and local wound care was started on post op day 1. Patients are discharged on day 3 or 4 after education. Outpatient review was performed on post op day 7/14.
Conclusions: Mechanical bowel preparation for elective colorectal surgery has a less significant role in children and does not affect the incidence of infectious complications. A larger multi-institutional study is necessary to validate the results that the amount of stooling has less impact on wound infection rates.