Elective oncologic colorrectal surgery without mechanical colon preparation
Keywords:
Cancer, Colorectal surgery, Complications, Perioperative careAbstract
Introduction: mechanical preparation of the colon in elective oncological colorectal surgery is increasingly questionable, as it does not show important benefits for the patient.
Objective: to argue the increasing use of oncological colorectal surgery without mechanical preparation of the colon, as well as the necessary implementation and updating of the ERAS protocol.
Methods: an extensive search and narrative bibliographic review was carried out through the Google Scholar search engine in databases such as Scielo, Pubmed, Medline, Scopus to obtain and compile all the necessary information in relation to new trends in colorectal oncological surgery and mechanical colon preparation. Articles and theses in Spanish and English were taken into account; years of publication were not defined to exclude or include studies in order to compare the evolution of the content over time in relation to the topic addressed.
Development: the colon is a reservoir of germs, since feces contain huge amounts of them. Although mechanical preparation of the colon reduces their total number, it does not alter the residual bacterial concentration, and it has even been shown in studies that only that of gramnegative aerobes is modified, and antibiotic prophylaxis is necessary to reduce the presence of anaerobic germs. The reality is that there has been no demonstration that biomechanical preparation of the colon does not reduce morbidity and mortality, nor has it been defined how clean the colon must be to prevent adverse effects, since this is not about having optimal endoscopic vision, but about improving safety. Thus, some of the previous statements seem to be nothing more than speculations repeatedly repeated in the bibliography.
Conclusions: the implementation of the ERAS protocol continues to be a challenge for any medical-surgical institution, without a doubt elective oncological colorectal surgery without mechanical preparation of the colon continues to take steps towards a future where science based on scientific evidence indicates an increasingly more use rational.
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