Fu Cuixia,Zhu Weina,Ma Lili,et al.The impact of non mechanical preoperative intestinal preparation on the safety, intestinal function recovery,and complications of pediatric colostomy return surgery[J].Journal of Clinical Pediatric Surgery,,():667-671.[doi:10.3760/cma.j.cn101785-202509030]
The impact of non mechanical preoperative intestinal preparation on the safety, intestinal function recovery,and complications of pediatric colostomy return surgery
- Keywords:
- Intestinal Lavage; Bowel Preparation; Surgical Therapy; Child
- Abstract:
- Objective To explore the effects of non-mechanical preoperative bowel preparation on safety,bowel function returning and postoperative complications among children with ostomy reversal. Methods This study collected data from 86 pediatric patients with colostomy admitted to the Department of Surgery at Fudan University Affiliated Children’s Hospital from January 2022 to December 2023 for retrospective analysis. They were assigned into two groups of MBP (n=50) and NMBP (n=36) based upon type of preoperative bowel preparation.Inpatient preoperative waiting time,operative duration,dosing duration of postoperative intravenous antibiotic,postoperative enteral feeding starting time,time to full enteral feeding,postoperative complications and clinical outcomes were examined.Results As compared with MBP group,NMBP group manifested a shorter waiting time pre-operation[2.00(2.00,2.25) vs.3.00(3.00,3.00) day]and time to achieve total enteral nutrition became significantly shortened[2.50(2.00,3.00) vs.5.50 (3.00,8.00) day].The inter-group differences were statistically significant (P<0.01).No statistically significant inter-group difference existed (P>0.05) in operative duration[2.39(1.63,2.59) vs.2.27(1.82,2.92) hours],dosing duration of postoperative antibiotic[7.50(6.00,9.00) vs.8.00(5.75,9.00)day],duration of postoperative enteral nutrition[5.00(5.00,6.00) vs.5.50(5.00,7.00) day],length of postoperative hospitalization[10.00(8.00,13.50) vs.15.00(9.00,22.50) day],the incidence of postoperative wound infection (2%,1/50 vs.0%,0/36) or the incidence of anastomotic fistula (2%,1/50 vs.0%,0/36). Conclusions NMBP does not either elevate the risk of ostomy reversal or affect the surgical efficacy in children.Additionally,it also benefits bowel function recovery postoperatively.
References:
[1] 中华医学会小儿外科分会,中华医学会麻醉学分会小儿麻醉学组.加速康复外科指导下的儿童围手术期处理专家共识[J].中华小儿外科杂志,2021,42(12):1057-1065.DOI:10.3760/cma.j.cn421158-20210822-00417. Pediatric Surgery Branch of Chinese Medical Association,Pediatric Anesthesiology Group,Chinese Society of Anesthesiology.Expert consensus on perioperative management of children under the guidance of enhanced recovery after surgery[J].Chin J Pediatr Surg,2021,42(12):1057-1065.DOI:10.3760/cma.j.cn421158-20210822-00417.
[2] Cao F,Li J,Li F.Mechanical bowel preparation for elective colorectal surgery:updated systematic review and meta-analysis[J].Int J Colorectal Dis,2012,27(6):803-810.DOI:10.1007/s00384-011-1361-y.
[3] Rosenfeld EH,Yu YR,Fernandes NJ,et al.Bowel preparation for colostomy reversal in children[J].J Pediatr Surg,2019,54(5):1045-1048.DOI:10.1016/j.jpedsurg.2019.01.037.
[4] 郑珊.实用新生儿外科学[M].北京:人民卫生出版社,2013:191-192. Zheng S.Practice of newborn surgery[M].Beijing:People’s Medical Publishing House,2013:191-192.
[5] 吕泽坚,梁伟俊,林圳滨,等.中国择期结直肠手术术前肠道准备现状调查[J].中华胃肠外科杂志,2020,23(6):578-583.DOI:10.3760/cma.j.cn.441530-20190611-00238. Lyu ZJ,Liang WJ,Lin ZB,et al.Current practice patterns of preoperative bowel preparation in elective colorectal surgery:a nation-wide survey of Chinese surgeons[J].Chin J Gastrointest Surg,2020,23(6):578-583.DOI:10.3760/cma.j.cn.441530-20190611-00238.
[6] 邹镇洪,赵丽瑛,吴佳明,等.择期结直肠手术前机械性肠道准备的研究进展[J].中华胃肠外科杂志,2015,18(6):628-630.DOI:10.3760/cma.j.issn.1671-0274.2015.06.028. Zou ZH,Zhao LY,Wu JM,et al.Research progression on preoperative mechanical bowel preparation for elective colorectal surgery[J].Chin J Gastrointest Surg,2015,18(6):628-630.DOI:10.3760/cma.j.issn.1671-0274.2015.06.028.
[7] Hosseinpour M,Ahmadi B,Etezazian S.Mechanical bowel preparation versus no preparation in Duhamel procedure in children with Hirschsprung’s disease[J].Eur J Pediatr Surg,2020,30(2):201-204.DOI:10.1055/s-0039-1681024.
[8] Janssen Lok M,Miyake H,O’Connell JS,et al.The value of mechanical bowel preparation prior to pediatric colorectal surgery:a systematic review and meta-analysis[J].Pediatr Surg Int,2018,34(12):1305-1320.DOI:10.1007/s00383-018-4345-y.
[9] Aldrink JH,McManaway C,Wang W,et al.Mechanical bowel preparation for children undergoing elective colorectal surgery[J].J Pediatr Gastroenterol Nutr,2015,60(4):503-507.DOI:10.1097/MPG.0000000000000651.
[10] Leal AJG,Tannuri ACA,Tannuri U.Mechanical bowel preparation for esophagocoloplasty in children:is it really necessary?[J].Dis Esophagus,2013,26(5):475-478.DOI:10.1111/j.1442-2050.2012.01378.x.
[11] Liang YY,Xin WQ,Xi L,et al.Role of mechanical and oral antibiotic bowel preparation in children with Hirschsprung’s disease undergoing colostomy closure and pull-through[J].Transl Pediatr,2021,10(1):153-159.DOI:10.21037/TP-20-306.
[12] 路航,唐杰,唐维兵.经典型先天性巨结肠手术时机与术前肠道管理的研究进展[J].临床小儿外科杂志,2024,23(4):395-400.DOI:10.3760/cma.j.cn101785-202304044-018. Lu H,Tang J,Tang WB.Research advances on operative timing and preoperative bowel management of classic Hirschsprung’s disease[J].J Clin Ped Sur,2024,23(4):395-400.DOI:10.3760/cma.j.cn101785-202304044-018.
Memo
收稿日期:2025-9-13。
基金项目:厦门市科技局2023年赛马制揭榜挂帅科技计划项目(3502Z20241003);复旦大学上海医学院青年临床科学家项目(DGF828019—2/034)
通讯作者:朱海涛,Email:zhuhaitao@shchildren.com.cn