Utilidad de la preparación mecánica anterógrada en cirugía colorrectal electiva. Resultados de una serie prospectiva y aleatoria

• ALEJANDRO BARRERA E ^[1] ; HÉCTOR CID B ^[1] ; GUILLERMO BANNURA C ^[1] ; JAIME CONTRERAS R ^[1] ; CLAUDIO ZÚÑIGA T ^[1] ; JUAN MANSILLA E ^[1]
  1. [1] Universidad de Chile Facultad de Medicina Hospital Clínico San Borja Arriarán
• Localización: Revista chilena de cirugía, ISSN-e 0718-4026, ISSN 0379-3893, Vol. 64, Nº. 4, 2012, págs. 373-377
• Idioma: español
• Títulos paralelos:
  • Usefuh1ess of anterograde mechanical colon cleansing in colorectal surgery
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• Resumen
  • español

    Introducción: El uso de Ia preparación mecánica anterógrada (PMA) es una práctica rutinaria en cirugia colorrectal pero con escasas bases en Ia evidencia científica. Objetivo: Determinar Ia utilidad de Ia PMA en una serie prospectiva y aleatoria de cirugía colorrectal electiva. Resultados: La serie corresponde a 122 pacientes, 60 de Ios cuales recibe PMA. Los datos epidemiológicos muestran que Ios grupos son comparables. En esta serie se encuentra un riesgo de morbilidad global aumentado al doble en Ios pacientes que reciben PMA, así como un riesgo de infección superficial del sitio quirúrgico seis veces mayor. No se encuentran diferencias en Ias infecciones profundas, dehiscencia de anastomosis ni en Ias reintervenciones. Las complicaciones asociadas a Ia PMA se presentaron sólo en un caso, 10 que no alcanza significación estadística. Conclusiones: De acuerdo a nuestros resultados, no sejustifica Ia utilización rutinaria de PMA.

  • English

    Background: Anterograde mechanical colon cleansing is routinely done before colorectal surgery. However there is no firm evidence about its usefulness. Aim: To assess the usefulness of anterograde mechanical colon cleansing in colon surgery. Patients and Methods: Participants requiring elective colorectal surgery were randomized to receive anterograde mechanical bowel cleansing with two doses of oral sodium phosphate (Oral fleet*) or a liquid diet 24 hours prior to surgery, after signing an informed consent. Both groups received antimicrobial prophylaxis. Problems associated with bowel cleansing, subjective assessment ofbowel preparation by the surgeon and postoperative complications were recorded. Results: One hundred twenty two participants were studied (73 females). Fifty three percent of patients had concomitant diseases such as hypertension and diabetes mellitus. Sixty patients were subjected to anterograde bowel cleansing and 62 were ascribed to the liquid diet group. Surgeons evaluated colon cleansing as good in 49 and 37 patients with and without anterograde mechanical cleansing, respectively and as regular in 8 and 23 patients, respectively (χ2 = 9.1 p = 0.01). Tolerance to cleansing was evaluated as good, fair and poor by 50, 30 and 20% of patients, respectively. One patient had a bowel obstruction associated with the use of sodium phosphate. Postoperative complications occurred in 14 and 23 patients subjected or not to cleansing, respectively (p = 0.06). Septic complications occurred in 11 and 3 cases with and without colon cleansing, respectively (p < 0.01). Conclusions: Anterograde mechanical colon cleansing was associated with a higher incidence of septic complications in this series of patients.