Mechanical and oral antibiotic bowel preparation may reduce morbidity in patients undergoing elective rectal resection: JAMA

Surgical site infections (SSIs)—especially anastomotic dehiscence—are major contributors to morbidity and mortality after rectal resection. The role of mechanical and oral antibiotics bowel preparation (MOABP) in preventing complications of rectal resection is currently disputed. A study was done to assess whether MOABP reduces overall complications and SSIs after elective rectal resection compared with mechanical bowel preparation (MBP) plus placebo. This multicenter, double-blind, placebo-controlled randomized clinical trial was conducted at 3 university hospitals in Finland between March 18, 2020, and October 10, 2022. Patients aged 18 years and older undergoing elective resection with primary anastomosis of a rectal tumour 15 cm or less from the anal verge on magnetic resonance imaging were eligible for inclusion. Outcomes were analyzed using a modified intention-to-treat principle, including all patients randomly allocated to and underwent elective rectal resection with an anastomosis. Patients were stratified according to tumour distance from the anal verge and neoadjuvant treatment given and randomised in a 1:1 ratio to receive MOABP with an oral regimen of neomycin and metronidazole (n = 277) or MBP plus matching placebo tablets (n = 288). All study medications were taken the day before surgery, and all patients received intravenous antibiotics approximately 30 minutes before surgery.

The primary outcome was overall cumulative postoperative complications measured using the Comprehensive Complication Index. Key secondary outcomes were SSI and anastomotic dehiscence within 30 days after surgery. Results In all, 565 patients were included in the analysis, with 288 in the MBP plus placebo group and 277 in the MOABP group. Patients in the MOABP group experienced fewer overall postoperative complications; Wilcoxon effect size, 0.146; P < .001), fewer SSIs, and fewer anastomotic dehiscences compared with patients in the MBP plus placebo group. Findings of this randomized clinical trial indicate that MOABP reduced overall postoperative complications and rates of SSIs and anastomotic dehiscences in patients undergoing elective rectal resection compared with MBP plus placebo. Based on these findings, MOABP should be considered as standard treatment in patients undergoing elective rectal resection.

Reference:

Koskenvuo L, Lunkka P, Varpe P, et al. Morbidity After Mechanical Bowel Preparation and Oral Antibiotics Prior to Rectal Resection: The MOBILE2 Randomized Clinical Trial. JAMA Surg. Published online March 20, 2024. doi:10.1001/jamasurg.2024.0184