Outcome of no oral antibiotic prophylaxis and bowel preparation in Crohn's diseases surgery

BackgroundRecent studies support the use of mechanical bowel preparation and/or oral antibiotic prophylaxis in patients operated on for Crohn's disease (CD); however, data are scarce, especially for laparoscopic surgery. Therefore, this study was carried out to investigate the effect of laparoscopic surgery on complication rates in patients not undergoing standardized bowel preparation but single shot antibiotics.MethodsIn this study 255 consecutive patients who underwent alaparoscopic intestinal resection for CD at atertiary referral center between 1997 and 2014 were retrospectively analyzed. Superficial surgical site infections (SSI), organ/space infections and ileus were recorded and grouped according to the type of resection (colorectal vs. small intestineileocecal).ResultsThe baseline characteristics of the groups were comparable. Colorectal resections showed asignificantly increased risk of organ/space infection (4.6% in small intestine +/- ileocecal vs. 14.3% in colorectal resections p=0.039). The superficial SSI rate was low in both groups (1.8% in small intestine +/- ileocecal resection vs. 0% in colorectal resections, p=1.000). Univariate binary logistic regression analysis revealed astatistically significant influence of duration of surgery (p=0.001) and type of resection (p=0.031) on organ/space infection. In multivariate analysis, only duration of surgery (OR 1.111, 95% CI 1.026-1.203 for every 10min, p=0.009) remained significant for postoperative organ/space infections.ConclusionsSingle-shot antibiotic therapy without bowel preparation is safe in patients undergoing minimally invasive surgery and was associated with alow number of complications; however, organ/space infections were more common if colorectal resections were performed. Therefore, combined bowel preparation might be beneficial when the (sigmoid) colon or rectum are involved.