Mechanical bowel preparation for elective colorectal surgery

Katia F Güenaga; Delcio Matos; Peer Wille‐Jørgensen

doi:10.1002/14651858.CD001544.pub4

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Analysis 1.1

Comparison 1 Mechanical bowel preparation versus no preparation, Outcome 1 Anastomosis leakage stratified for colonic or rectal surgery.

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Analysis 1.2

Comparison 1 Mechanical bowel preparation versus no preparation, Outcome 2 Overall anastomotic leakage for colorectal surgery.

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Analysis 1.3

Comparison 1 Mechanical bowel preparation versus no preparation, Outcome 3 Mortality.

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Analysis 1.4

Comparison 1 Mechanical bowel preparation versus no preparation, Outcome 4 Peritonitis.

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Analysis 1.5

Comparison 1 Mechanical bowel preparation versus no preparation, Outcome 5 Reoperation.

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Analysis 1.6

Comparison 1 Mechanical bowel preparation versus no preparation, Outcome 6 Wound infection.

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Analysis 1.7

Comparison 1 Mechanical bowel preparation versus no preparation, Outcome 7 Infectious extra‐abdominal complications.

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Analysis 1.8

Comparison 1 Mechanical bowel preparation versus no preparation, Outcome 8 Non‐infectious extra‐abdominal complications.

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Analysis 1.9

Comparison 1 Mechanical bowel preparation versus no preparation, Outcome 9 Sensitivity analysis 1 ‐ Including only studies with adequate randomisation.

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Analysis 1.10

Comparison 1 Mechanical bowel preparation versus no preparation, Outcome 10 Sensitivity analysis 2 ‐ Studies including only patients with anastomosis.

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Analysis 2.1

Comparison 2 Mechanical bowel preparation versus rectal enema, Outcome 1 Anastomotic leakage for colorectal surgery.

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Analysis 2.2

Comparison 2 Mechanical bowel preparation versus rectal enema, Outcome 2 Overall anastomotic leakage.

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Analysis 2.3

Comparison 2 Mechanical bowel preparation versus rectal enema, Outcome 3 Mortality.

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Analysis 2.4

Comparison 2 Mechanical bowel preparation versus rectal enema, Outcome 4 Peritonitis / Abscess.

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Analysis 2.5

Comparison 2 Mechanical bowel preparation versus rectal enema, Outcome 5 Reoperation.

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Analysis 2.6

Comparison 2 Mechanical bowel preparation versus rectal enema, Outcome 6 Wound infection.

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Comparison 1. Mechanical bowel preparation versus no preparation

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Anastomosis leakage stratified for colonic or rectal surgery Show forest plot	11		Peto Odds Ratio (Peto, Fixed, 95% CI)	Subtotals only

1.1 Leakage after low anterior resection	7	846	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.88 [0.55, 1.40]
1.2 Leakage after colonic surgery	8	3147	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.85 [0.58, 1.26]
2 Overall anastomotic leakage for colorectal surgery Show forest plot	13	4533	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.99 [0.74, 1.31]

3 Mortality Show forest plot	11	4166	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.93 [0.58, 1.47]

4 Peritonitis Show forest plot	10	3983	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.74 [0.50, 1.08]

5 Reoperation Show forest plot	11	4319	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.04 [0.81, 1.34]

6 Wound infection Show forest plot	13	4595	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.16 [0.95, 1.42]

7 Infectious extra‐abdominal complications Show forest plot	6	3575	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.05 [0.85, 1.30]

8 Non‐infectious extra‐abdominal complications Show forest plot	6	2346	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.98 [0.71, 1.36]

9 Sensitivity analysis 1 ‐ Including only studies with adequate randomisation Show forest plot	9		Odds Ratio (M‐H, Random, 95% CI)	Subtotals only

9.1 Overall anastomotic leakage for colorectal surgery	9	3854	Odds Ratio (M‐H, Random, 95% CI)	0.88 [0.64, 1.23]
9.2 Wound infection	9	3875	Odds Ratio (M‐H, Random, 95% CI)	1.13 [0.91, 1.40]
10 Sensitivity analysis 2 ‐ Studies including only patients with anastomosis Show forest plot	8		Odds Ratio (M‐H, Random, 95% CI)	Subtotals only

10.1 Overall anastomotic leakage for colorectal surgery	8	3792	Odds Ratio (M‐H, Random, 95% CI)	0.92 [0.60, 1.41]
10.2 Wound infection	8	3837	Odds Ratio (M‐H, Random, 95% CI)	1.07 [0.86, 1.35]

Comparison 1. Mechanical bowel preparation versus no preparation

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Comparison 2. Mechanical bowel preparation versus rectal enema

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Anastomotic leakage for colorectal surgery Show forest plot	3	763	Odds Ratio (M‐H, Fixed, 95% CI)	1.43 [0.71, 2.87]

1.1 Leakage after rectal surgery	3	195	Odds Ratio (M‐H, Fixed, 95% CI)	0.93 [0.34, 2.52]
1.2 Leakage after colonic surgery	3	568	Odds Ratio (M‐H, Fixed, 95% CI)	2.15 [0.79, 5.84]
2 Overall anastomotic leakage Show forest plot	5	1210	Odds Ratio (M‐H, Fixed, 95% CI)	1.32 [0.74, 2.36]

3 Mortality Show forest plot	5	1210	Odds Ratio (M‐H, Fixed, 95% CI)	1.47 [0.56, 3.90]

4 Peritonitis / Abscess Show forest plot	5	1210	Odds Ratio (M‐H, Fixed, 95% CI)	1.37 [0.64, 2.93]

5 Reoperation Show forest plot	2	447	Odds Ratio (M‐H, Fixed, 95% CI)	0.86 [0.32, 2.33]

6 Wound infection Show forest plot	5	1210	Odds Ratio (M‐H, Fixed, 95% CI)	1.26 [0.85, 1.88]

Comparison 2. Mechanical bowel preparation versus rectal enema

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