Schardey Josefine, von Ahnen Thomas, Crispin Alexander, Knoblauch Mathilda, Zimmermann Petra, Kühn Florian, Andrassy Joachim, Werner Jens, Rau Bettina M, Wirth Ulrich
Department of General, Visceral and Transplantation Surgery, LMU University Hospital, LMU Munich, Munich, Germany.
Department of General, Visceral, Vascular and Endocrine Surgery, Agatharied Hospital, Hausham, Germany.
Visc Med. 2025 Apr;41(2):92-99. doi: 10.1159/000543432. Epub 2025 Jan 8.
Infectious complications, such as anastomotic leakage (AL) and surgical site infections (SSIs), remain a significant challenge in colorectal surgery. Consequently, there is growing interest in oral antibiotic bowel decontamination with nonabsorbable antibiotics (selective digestive decontamination or SDD), which can reduce perioperative complications while also minimizing antibiotic use. This study aimed to determine whether a 3-day SDD regimen is as effective as a 7-day regimen in preventing postoperative complications in laparoscopic diverticular surgery.
A bicenter data analysis of prospectively and retrospectively collected patient data was performed. A 3-day versus 7-day perioperative use of an SDD-based regimen (polymyxin B, gentamicin, vancomycin, and amphotericin B) in patients undergoing minimally invasive surgery for diverticular disease was compared using noninferiority analysis.
A total of 469 patients were included in the analysis: 101 patients received a 3-day perioperative SDD regimen, while 368 patients received a 7-day regimen. Due to the use of routine clinical data, no control cohort is available. The overall complication rate was 16.5% in both groups. AL and SSI occurred in 2.0% and 6.0% of the 3-day group, and in 1.4% and 6.3% of the 7-day group, respectively, with no significant differences between the groups. However, for wound infections and overall infectious complications, the 3-day regimen can be considered noninferior to the 7-day regimen. Our data did not confirm the noninferiority of the SDD3 regimen compared to the SDD7 regimen for AL.
We report low rates of AL and other surgical and nonsurgical complications in minimally invasive diverticular disease surgery. The low complication rates demonstrate noninferiority regarding SSI. Our findings are consistent with recent evidence, highlighting the positive impact of perioperative SDD treatment on SSI and infectious complications.
感染性并发症，如吻合口漏（AL）和手术部位感染（SSI），仍然是结直肠手术中的一项重大挑战。因此，人们对使用不可吸收抗生素进行口服抗生素肠道去污（选择性消化道去污或SDD）的兴趣日益浓厚，这种方法可以减少围手术期并发症，同时尽量减少抗生素的使用。本研究旨在确定3天的SDD方案在预防腹腔镜憩室手术术后并发症方面是否与7天方案同样有效。
对前瞻性和回顾性收集的患者数据进行双中心数据分析。使用非劣效性分析比较了接受基于SDD方案（多粘菌素B、庆大霉素、万古霉素和两性霉素B）进行3天与7天围手术期治疗的憩室病微创手术患者。
共有469例患者纳入分析：101例患者接受了3天围手术期SDD方案，368例患者接受了7天方案。由于使用的是常规临床数据，没有可用的对照组。两组的总体并发症发生率均为16.5%。3天组的AL和SSI发生率分别为2.0%和6.0%，7天组分别为1.4%和6.3%，两组之间无显著差异。然而，对于伤口感染和总体感染性并发症，3天方案可被认为不劣于7天方案。我们的数据未证实SDD3方案相对于SDD7方案在预防AL方面的非劣效性。
我们报告了微创憩室病手术中AL及其他手术和非手术并发症的发生率较低。低并发症发生率表明在SSI方面具有非劣效性。我们的研究结果与最近的证据一致，突出了围手术期SDD治疗对SSI和感染性并发症的积极影响。
