Surgery Bowel Prep

[DustyKat]

Did you have bowel prep prior to having surgery?

Sarah had emergency surgery so no bowel prep.

Matt had planned surgery and didn't have bowel prep either.

Dusty.

 

[Jennifer]

I had mine over 10 years ago and am baffled that there is no bowel prep for some people if not all people now. Dunno when this change took place but I also noticed that people are put on antibiotics automatically as well even though there is no infection which they also didn't do back when I had mine done. Connection? Maybe. One would think that loosed fecal matter could cause an infection but I honestly have no idea.

 

[DustyKat]

Sarah had antibiotics post op in hospital because her bowel was ruptured but Matt's 3 months of Flagyl is because the GI Prof reckons that research suggests 3 months of Flagyl post op greatly increases the chances of a longer remission...(shrug).

Dusty.

 

[Beeracuda]

Yes, I had to take something called MoviPrep the day/night before my surgery. That stuff was awful! Tasted like salty lemon-flavored Pledge, and I had to drink 2 whole liters of it in 2 hours!! UGH!!

 

[Gue33]

I was on TPN for a month before my surgery. We were hoping the holes would heal, didn't work.

 

[davers2005]

i had nothing before and nothing after, this was 5 yrs ago. back on the meds now. budesonide, prednisolone, and 6mp. just thinking on having the op again. i opted out of the infliximab. they did tell me back when i had the op, why they don't flush you out (so to speak) before hand. but i can't remember. will maybe find out again soon. will let you know when i do.

 

[archie]

I didn't have to take any prep 8 months ago, but i did have to take 3 high calorie drinks 2 the night before and one the morning of the surgery, yet again it was another foul tasting substance so instead i ate a tub of ice-cream I reaconed if it was calories they wanted me to have then there were nicer ways to do it!!!!!!!

 

[LOSTnut]

No on both accounts. But, for the planned one I was on clear fluids anyway, so I don't think that was much of an issue. And, for emergency surgery ... no time!

Although, they tried to get me to do a prep for a colonoscopy while I had a draining fistula but I refused after having it spew out front and back .....

 

[vonfunk]

I was told no prep, just a day of clear fluids.

 

[Terriernut]

They starved me for 3 days in hospital awaiting surgery. No fluid either. Just a drip. :ymad:

My tongue was so swollen I couldnt speak! (it was only afterward a friend told me they give you sponges to wet your tongue..I wasnt offered any! I sounded like a drugged fiend when I tried to speak..everyone thought I was on major pain meds and was on nothing!)

 

[Sailorluna]

I had a tpn and clear liquids for a week. No antibiotics after.
It sucks watching the food channel while all you get is broth and ice cubes.

Terrie I am sorry that they didn't even give you those sponge things. That's awful.

 

[LOSTnut]

Misty, they didn't offer the spongy thingys to me either ... I had to ask for them.

 

[Terriernut]

By the time I asked for them, a friend helped, I wasssssssssssshhhhhhttalkkinchhhglaaaaaaaaaaakkkeeedissssssssssssssss

:voodoo:

 

[DougUte]

I had the same bowel prep as I did for a colonoscopy.

 

[DustyKat]

Colorectal surgery related but not specific to IBD:

Antibiotic bowel prep significantly reduces colon surgery infections

SAN FRANCISCO – Oral antibiotics with mechanical bowel preparation significantly reduce surgical site infections, length of hospital stay, and readmissions in both open and laparoscopic elective colorectal surgery, according to a review of 8,415 cases in the National Surgery Quality Improvement Program.

It “should be adopted for elective colorectal surgery,” concluded the investigators, led by colorectal surgeon Melanie Morris of the University of Alabama at Birmingham.

A quarter of the patients had no bowel prep, 45% had mechanical prep alone – GoLytely or another laxative, and 30% received both oral antibiotics and mechanical prep. Partial colectomy and sigmoid resections were the most common procedures, generally for neoplasms or diverticulitis.

Overall, 15% of the no-prep group, 12% of the mechanical prep group, and 6.5% of the oral antibiotic plus mechanical prep group developed subsequent surgical site infections (SSIs), a statistically significant difference. Results were similar when broken down into superficial, deep wound, and organ space infections (J. Am. Coll. Surg. 2014:219;S18-19).

On multivariate analysis and after adjusting for diabetes, smoking, age, and other potential confounders, the antibiotic group was 54% less likely than the no-prep group to develop an SSI (odds ratio 0.46), 26% less likely to be readmitted (OR 0.74), and more likely to leave the hospital earlier, at about 4 days instead of 5 (OR 0.90). SSIs and readmissions were only slightly less likely in the mechanical prep–only group, compared with the no-prep group, and there was no difference in length of stay.

There were fewer anastomotic leaks, fewer cases of sepsis, less significant bleeding, and other benefits for oral antibiotics with mechanical preparation. In addition, there was a protective effect against 30-day mortality in open procedures.

“Even in the minimally invasive group,” about two-thirds of patients, “oral antibiotic prep … was protective for surgical site infections,” Dr. Morris said at the annual clinical congress of the American College of Surgeons.

Still, bowel prep remains “a very controversial topic.” Nationwide some surgeons prep, some don’t. “People have very strong beliefs that may or may not be rooted in the data,” she said.

There are concerns about fluid and electrolyte disturbances, Clostridium difficile overgrowth, and other potential problems. Plus, mechanical preparation hasn’t worked any better than placebo in recent studies, but many of those studies didn’t include oral antibiotics. Effective bowel prep includes both, Dr. Morris said.

It’s possible that confounders might have been at work in the Alabama study. Perhaps surgeons shied away from bowel prep in older, sicker patients, but the rate of acute renal injury was the same in all three study groups at about 0.9%, suggesting similar background comorbidities.

“I don’t think confounding issues” explain the findings. Previously, “we’ve shown the benefit of oral antibiotic bowel prep in a [Veterans Affairs] cohort, and now we’ve shown it in this national cohort,” Dr. Morris said (Dis. Colon. Rectum 2012;55:1160-6).

After a marked reduction in surgical site infections in the VA study, “we changed our practices. We now do mechanical and oral antibiotic preps and have seen a 50% reduction in our SSI rate. We don’t feel like we are doing anything else differently,” she said.

Dr. Morris has no disclosures.

http://www.gihepnews.com/news/top-news/single-article/antibiotic-bowel-prep-significantly-reduces-colon-surgery-infections/7f18cfd06f11a35eb1d8d7bb766b8afa.html?tx_ttnews%5BsViewPointer%5D=1

 

[2thFairy]

I've done a bowel prep prior to EVERY abdominal surgery I have had, including hysterectomy and cholecystectomy.

 

[TLF1996]

I took picoprep before surgery which is truly revolting stuff.

 

[emmaaaargh]

This is a really interesting thread! I wonder why there's such inconsistency?

I had two enemas before my surgery - one at midnight the night before (before which I could eat as I wanted, but hadn't since about 4pm that day) and one at 6am on the morning of the procedure. Absolutely horrific and pretty undignified, too, since the nurse initially wanted me to just go into a bedpan and my mum had to fight to get me a commode to sit on. I would've much preferred regular colonoscopy prep, I think.

 

[Krissy]

I had left hemicolectomy 6wks ago and the only prep I had to do was an enema the evening before and in the morning, I've only ever had moviprep for a colonoscopy .

 

[Plissken]

Yes I did I was given 2 sachets of Picolax to drink the day before. Made me very sick! I vomited about an hour after each dose. Felt awful. Then the surgeon told me on the day of the operation that it isn't essential, it's just better because otherwise they have to move poo out the way when operating.

I think if I did it again I would just not eat for two days and use milder laxatives, not something as aggressive as Picolax.

My surgery was Laparoscopic colorectal surgery.