Department of Surgery, Isala Hospital, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
Department of Surgery, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
Updates Surg. 2019 Jun;71(2):227-236. doi: 10.1007/s13304-018-0526-4. Epub 2018 Mar 21.
It has been a standard practice to perform mechanical bowel preparation (MBP) prior to colorectal surgery to reduce the risk of colorectal anastomotic leakages (CAL). The latest Cochrane systematic review suggests there is no benefit for MBP in terms of decreasing CAL, but new studies have been published. The aim of this systematic review and meta-analysis is to update current evidence for the effectiveness of preoperative MBP on CAL in patients undergoing colorectal surgery. Consequently, PubMed, MEDLINE, Embase, CENTRAL and CINAHL were searched from 2010 to March 2017 for randomised controlled trials (RCT) that compared the effects of MBP in colorectal surgery on anastomotic leakages. The outcome CAL was expressed in odds ratios and analysed with a fixed-effects analysis in a meta-analysis. Quality assessment was performed by the cochrane risk of bias tool and grades of recommendation, assessment, development and evaluation (GRADE) methodology. Eight studies (1065 patients) were included. The pooled odds ratio showed no significant difference of MBP in colorectal surgery on CAL (odds ratio (OR) = 1.15, 95% CI = 0.68-1.94). According to GRADE methodology, the quality of the evidence was low. To conclude, MBP for colorectal surgery does not lower the risk of CAL. These results should, however, be interpreted with caution due to the small sample sizes and poor quality. Moreover, the usefulness of MBP in rectal surgery is not clear due to the lack of stratification in many studies. Future research should focus on high-quality, adequately powered RCTs in elective rectal surgery to determine the possible effects of MBP.
在结直肠手术前进行机械性肠道准备（MBP）已成为一种标准做法，以降低结直肠吻合口漏（CAL）的风险。最新的 Cochrane 系统评价表明，MBP 在降低 CAL 方面没有益处，但新的研究已经发表。本系统评价和荟萃分析的目的是更新目前关于 MBP 在接受结直肠手术的患者中预防 CAL 的有效性的证据。因此，从 2010 年到 2017 年 3 月，我们在 PubMed、MEDLINE、Embase、CENTRAL 和 CINAHL 上搜索了比较 MBP 在结直肠手术中对吻合口漏影响的随机对照试验（RCT）。CAL 的结果以优势比表示，并在荟萃分析中采用固定效应分析进行分析。质量评估由 Cochrane 偏倚风险工具和推荐、评估、制定和评价（GRADE）方法学进行。共纳入 8 项研究（1065 例患者）。汇总的优势比显示，MBP 在结直肠手术中对 CAL 没有显著差异（优势比（OR）=1.15，95%CI=0.68-1.94）。根据 GRADE 方法学，证据质量为低。总之，MBP 不能降低结直肠手术的 CAL 风险。但是，由于样本量小且质量差，这些结果应谨慎解释。此外，由于许多研究缺乏分层，MBP 在直肠手术中的作用尚不清楚。未来的研究应侧重于高质量、充分有力的 RCT，以确定 MBP 的可能效果。
