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Darmvorbereitung bei elektiven kolorektalen Resektionen in Deutschland 2017

Ergebnisse einer Umfrage unter den Mitgliedern der DGAV

Bowel preparation for elective colorectal surgery in Germany 2017

Results of a survey among members of the German Society of General and Visceral Surgery

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Zusammenfassung

Hintergrund

Die Morbidität nach kolorektalen Eingriffen ist nach wie vor hoch. Eine perioperative i.v. Antibiotikagabe zur Reduktion der Rate an Wundinfektionen hat sich als Standard etabliert. In der Diskussion ist der Stellenwert präoperativer Abführmaßnahmen. Es gibt Hinweise, dass Abführmaßnahmen in Kombination mit der Gabe oraler, nichtresorbierbarer Antibiotika die Rate an Anastomoseninsuffizienzen und postoperativen Wundinfekten signifikant zu senken vermögen.

Ziel der Arbeit

Um einen Überblick über den Stand der präoperativen Vorbereitungen vor elektiver Kolorektalchirurgie in Deutschland zu erhalten, initiierten wir eine Umfrage unter den Mitgliedern der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV).

Material und Methoden

Die über 5200 Mitglieder der DGAV erhielten im März 2017 per E‑Mail einen Zugang zu einem Onlinefragebogen zur Darmvorbereitung bei elektiver kolorektaler Chirurgie.

Ergebnisse

Insgesamt 557 Kollegen füllten den Fragebogen online aus. Bei den Kolonresektionen überwog die mechanische Darmvorbereitung mittels Abführmaßnahmen („mechanical bowel preparation“[MBP]/orthograde Darmspülung) in über 50 %. Bei Rektumresektionen mit Anastomose und geplantem protektivem Stoma überwiegt die mechanische Darmvorbereitung mittels Abführmaßnahmen (MBP/orthograder Darmspülung) mit 76,5 %. Eine orale Antibiotikagabe mit und ohne mechanischer Darmvorbereitung lag bei den Kolonresektionen unter 10 % bzw. 2 %; bei den Rektumresektionen mit und ohne MBP jeweils bei ca. 11 %.

Schlussfolgerung

Im Gegensatz zu den Hinweisen in der aktuellen Literatur, die Vorbereitung des Darmes mit mechanischen Abführmaßnahmen in Kombination mit einer oralen Antibiotikagabe bei kolorektalen Resektionen durchzuführen, findet diese Praxis unter den Teilnehmern unserer Umfrage nahezu keine Anwendung.

Abstract

Background

The morbidity after colorectal resection is still high. Perioperative i.v. antibiotic administration has become established as the standard to decrease the wound infection rate. An ongoing discussion is the status of preoperative mechanical bowel preparation. There seems to be evidence that mechanical bowel preparation in combination with administration of oral non-resorbable antibiotics significantly decreases the rate of anastomotic leakage and postoperative wound infections.

Objective

In order to obtain an overview on the state of preoperative preparation before elective colorectal surgery in Germany, a survey was initiated among the members of the German Society of General and Visceral Surgery.

Material and methods

In March 2017 the 5200 members of the German Society of General and Visceral Surgery (DGAV) received via email a link to an online survey on bowel preparation before elective colorectal surgery.

Results

A total of 557 colleagues answered the questionnaire online. Mechanical bowel preparation with orthograde lavage was the predominant method for bowel preparation prior to colon resection in over 50%. In rectal surgery with primary anastomosis and planned protective stoma, mechanical bowel preparation with orthograde lavage dominated with 76.5%. An oral antibiotic administration alone and in combination with mechanical bowel preparation for colon resection was used by less than 10% and 2%, respectively and ca. 11 % for rectal surgery both with and without mechanical bowel preparation.

Conclusion

In contrast to the evidence in the current literature to carry out preoperative mechanical preparation of the bowel in combination with an oral antibiotic administration prior to colorectal resection, in practice these recommendations have not become established among the participants of this survey.

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Authors and Affiliations

  1. Klinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Asklepios Klinik Langen, Röntgenstr. 20, 63225, Langen, Deutschland

    A. Buia & E. Hanisch

  2. Chirurgische Klinik, Universitätsmedizin Mannheim, Mannheim, Deutschland

    S. Post

  3. Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, Berlin, Deutschland

    H. J. Buhr

  4. Akademisches Lehrkrankenhaus Goethe-Universität Frankfurt, Frankfurt, Deutschland

    A. Buia

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  2. S. Post
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  4. E. Hanisch
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Correspondence to A. Buia.

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A. Buia, S. Post, H.J. Buhr und E. Hanisch geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Buia, A., Post, S., Buhr, H.J. et al. Darmvorbereitung bei elektiven kolorektalen Resektionen in Deutschland 2017. Chirurg 90, 564–569 (2019). https://doi.org/10.1007/s00104-018-0773-4

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