Does mechanical bowel preparation ameliorate damage from rectal injury in radical prostatectomy? Analysis of 151 rectal injury cases

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Abstract

Objective:

To evaluate whether mechanical bowel preparation before radical prostatectomy ameliorates damage from rectal injury in radical prostatectomy.

Methods:

Among 35 099 radical prostatectomy cases in the Japanese Diagnosis Procedure Combination database 2007–2012, those where a rectal injury occurred were stratified into a preoperative mechanical bowel preparation group (polyethylene glycol electrolyte, magnesium citrate solution and sodium picosulfate) and a non-mechanical bowel preparation group. The associations between mechanical bowel preparation and rectal injury were evaluated by multivariate regression analysis for: (i) subsequent infectious complications; (ii) requirement of delayed colostomy formation after primary closure; (iii) postoperative length of stay; and (iv) total costs. Covariates were age, surgical approach, Charlson Comorbidity Index, T and N category, hospital volume, hospital academic status, and colostomy formation.

Results:

Overall, 151 rectal injury cases (0.43%) were identified. Of those, 73 patients (48%) received mechanical bowel preparation. Multivariate analyses showed that all four outcomes were not statistically different between mechanical bowel preparation and non-mechanical bowel preparation groups (infectious complication rate: 12% vs 10%, P = 0.80; delayed colostomy rate: 21% vs 31%, P = 0.34; length of stay: 28 vs 30 days, P = 0.84; and total costs: $24 665 vs $23 837, P = 0.81).

Conclusion:

Our analysis did not detect a beneficial impact of mechanical bowel preparation on perioperative morbidity associated with rectal injury during radical prostatectomy. This finding suggests that mechanical bowel preparation might be safely omitted before radical prostatectomy.

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