Whole-gut irrigation versus enema in elective colorectal surgery

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Abstract
Whole-gut irrigation was compared with conventional mechanical bowel preparation in a prospective, randomized study. All 100 patients had a combination of ampicillin and metronidazole during and after colorectal surgery. Patients'' complaints were equally frequent during the 2 preparations and were severe in 15%. Gastric position of the tube for irrigation resulted in severe complaints in 3 of 26 patients and in the duodenal position, in severe complaints in 5 of 24. The time for irrigation was shorter than that for conventional preparation. Deep wound infections [from intestinal bacteria] were equally frequent after irrigation (3/46) and conventional preparation (4/47). Seven patients were excluded, since no bowel resection had been performed. Collapse of the small and large intestine, as evaluated blindly during surgery, was more frequent after irrigation (P < 0.05). Anastomotic leaks after left side resections were less frequent in patients with collapse of the small (P < 0.001) and large (P < 0.05) intestine. Five leakages among 29 patients after conventional preparation in contrast to one among 22 after whole-gut irrigation favor the latter, even if this difference did not reach statistical significance (0.05 < P < 0.10), since anastomotic leakage is lethal in a high number of patients.