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International Journal of Colorectal Disease

Published in:

01-12-2017 | Review

Preoperative optimization of patients with inflammatory bowel disease undergoing gastrointestinal surgery: a systematic review

Authors: Marie Strøm Zangenberg, Nir Horesh, Uri Kopylov, Alaa El-Hussuna

Published in: International Journal of Colorectal Disease | Issue 12/2017

Abstract

Purpose

Surgical management of inflammatory bowel disease (IBD) is a challenging task. The aim of preoperative optimization (PO) is to decrease the risk of complications and reduce the length of postoperative stay. The aim of this study was to review and grade the available evidence, attain clear recommendations, and point out potential future research.

Methods

Studies were identified from electronic databases (PubMed, Embase, and Cochrane Library) and scanning reference lists in relevant papers. English-written studies examining PO in adult patients with IBD were included. Eight PO factors were investigated.

Results

Management of IBD is a multidisciplinary task. Steroid withdrawal is recommended while steroid stress dose is not recommended. Thiopurines appear to be safe, but it may be prudent to plan the procedure remotely from the last dose of an anti-TNF agent. Nutritional risk screening is recommended to unveil and correct any malnutrition. Thrombosis prophylaxis prior to surgery is well supported by evidence while extended 4-week prophylaxis needs further research. Percutaneous ultrasound or CT-guided drainage for intra-abdominal abscesses is recommended, but it is unclear for how long supplementary antibiotics (ABs) should be used. Oral AB 24 h prior to open surgery might improve outcome if given as complementary to IV perioperative AB. Mechanical bowel preparation is not supported by evidence. Comorbidities must be treated accordingly prior to surgical intervention. Smoking cessation can be beneficial for wound healing.

Conclusion

Multimodel PO intervention in IBD patients is recommended.

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Title: Preoperative optimization of patients with inflammatory bowel disease undergoing gastrointestinal surgery: a systematic review
Authors: Marie Strøm Zangenberg
Nir Horesh
Uri Kopylov
Alaa El-Hussuna
Publication date: 01-12-2017
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 12/2017
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-017-2915-4

At a glance: The STEP trials

Springer Medicine

Preoperative optimization of patients with inflammatory bowel disease undergoing gastrointestinal surgery: a systematic review

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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