Please use this identifier to cite or link to this item: https://www.um.edu.mt/library/oar/handle/123456789/9505
Title: Pre-operative mechanical bowel preparation : an unnecessary procedure
Authors: Camilleri, Caroline
Keywords: Anastomotic leaks
Surgical wound infections
Bowel surgery
Colorectal surgery
Issue Date: 2013
Abstract: The use of Mechanical Bowel Preparation (MBP) in patients undergoing elective bowel surgery has been a traditionally held practice within the surgical domain in an attempt to reduce postoperative complications, mainly anastomotic leaks and postoperative infections. However, the surgical dogma surrounding the use of MBP started to be challenged by results coming up from research on emergency colon surgeries, which did not require the use of MBP (Zmora et al., 2003). In view of this emerging debate, the current investigation aimed to determine whether MBP does, in fact, reduce anastomotic leaks and postoperative infections following colon surgery using an evidence-based approach. As a result, the PICO question: In adult patients undergoing elective colon and rectal surgery, how does mechanical bowel preparation compared to no bowel preparation compare in reducing the risk of postoperative infections and anastomotic leaks?, was set. A search strategy, using the University of Malta e-library portal, has led to the identification of 7 meta-analyses, 3 systematic reviews, 8 RCTs and a prospective observational (cohort) study. Guiding this process, to minimize selection bias, was the use of established eligibility criteria, to include studies comparing the measured outcomes set for this investigation following the exposure of the mentioned intervention. Several combinations of relevant keywords were used to identify the 19 suitable research studies, retained for this investigation. These studies were appraised using the Critical Appraisal Skills Programme (CASP) tools for RCTs, systematic reviews and cohort studies, while the AMSTAR tool was used to appraise the meta-analyses. Results failed to show any statistical significant difference in reducing the risk of postoperative infections and anastomotic leaks between the two interventions (i.e. MBP and no MBP), thus leading to the conclusion that MBP is an unnecessary procedure prior to bowel surgery. This investigation recommends further larger research studies to confirm such conclusions and to expose these results to local stakeholders so that the suggested change in clinical practice is achieved for the benefit of our patients and of the local health care setting.
Description: B.SC.(HONS)HEALTH SCIENCE
URI: https://www.um.edu.mt/library/oar//handle/123456789/9505
Appears in Collections:Dissertations - FacHSc - 2013
Dissertations - FacHScNur - 2013

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