Slieker Juliette C, van't Sant Hans Pieter, Vlot John, Daams Freek, Jansen Frank Willem, Lange Johan F
Department of Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands.
J Laparoendosc Adv Surg Tech A. 2011 Dec;21(10):899-903. doi: 10.1089/lap.2011.0064. Epub 2011 Oct 19.
Much has been published on the role of mechanical bowel preparation (MBP) in open colorectal resection; however, the current study shows little evidence on the use of MBP prior to laparoscopic colorectal resections. In contrast to open procedures, MBP could influence the diameter of the bowel and thus the exposure of the surgical field in laparoscopy. This study aimed to assess the current practice of Dutch laparoscopic surgeons regarding MBP prior to colorectal resections.
In January 2010, members of the Dutch Association for Endoscopic Surgery were invited to fill out an online questionnaire investigating whether MBP is prescribed prior to laparoscopic colorectal surgery, and which considerations are taken into account when choosing or omitting MBP.
The 82 (49%) returned questionnaires showed that 20% of respondents prescribe MBP prior to colonic resections, while 63% prescribe MBP prior to rectal resections. The most common reasons for giving MBP were the construction of a protective ileostoma (22%), improvement of the surgical field exposure (16%), and "other reasons" specified by free text (21%). The three most common reasons for conversion were inadequate surgical field exposure (88%), locally advanced tumor (68%), and adhesions (29%). Concerning the question which stages of the operation are influenced by MBP, 29% of respondents believed that the diameter of the small bowel was influenced by MBP, 29% indicated that the exposure of the surgical field was influenced by MBP, and 52% did not believe that any of the stages of the operation were influenced by MBP.
The results of this questionnaire indicate that the implementation of MBP in laparoscopic colorectal surgery is based on individual preferences in the Netherlands. This emphasizes the need of new studies investigating the role of MBP on surgical field exposure in colorectal laparoscopic surgery.
关于机械性肠道准备（MBP）在开放性结直肠切除术中的作用已有大量文献发表；然而，目前的研究表明，关于在腹腔镜结直肠切除术前使用MBP的证据很少。与开放手术不同，MBP可能会影响肠管直径，进而影响腹腔镜手术视野的暴露。本研究旨在评估荷兰腹腔镜外科医生在结直肠切除术前使用MBP的现状。
2010年1月，邀请荷兰内镜外科学会的成员填写一份在线问卷，调查在腹腔镜结直肠手术前是否开具MBP，以及在选择或省略MBP时考虑了哪些因素。
82份（49%）回复的问卷显示，20%的受访者在结肠切除术前开具MBP，而63%的受访者在直肠切除术前开具MBP。给予MBP的最常见原因是构建保护性回肠造口（22%）、改善手术视野暴露（16%）以及自由文本中指定的“其他原因”（21%）。转为开放手术的三个最常见原因是手术视野暴露不足（88%）、局部晚期肿瘤（68%）和粘连（29%）。关于MBP影响手术的哪些阶段这一问题，29%的受访者认为MBP会影响小肠直径，29%表示MBP会影响手术视野暴露，52%不认为手术的任何阶段会受到MBP的影响。
这份问卷的结果表明，在荷兰，腹腔镜结直肠手术中MBP的实施基于个人偏好。这强调了需要开展新的研究来调查MBP在结直肠腹腔镜手术中对手术视野暴露的作用。
