Role of Mechanical Bowel Preparation and Perioperative Antibiotics in Pediatric Pull-Through Procedures.
BACKGROUND
There are no clear guidelines for the use of mechanical bowel preparation and postoperative antibiotics in children undergoing elective colorectal pull-through surgery. The objective of this study was to determine whether preoperative bowel preparation administration or duration of postoperative antibiotics impacted the rate of complications after elective pediatric pull-through surgery.


MATERIALS AND METHODS
Patients aged <18 y who underwent a pull-through procedure between 2011 and 2017 were retrospectively identified. Patient data included diagnosis, procedure, administration of mechanical bowel preparation, and duration of perioperative intravenous (IV) antibiotics. Outcomes of interest included surgical site infections and anastomotic complications.


RESULTS
A total of 180 patients met inclusion criteria, of which 47.2% received mechanical bowel preparation. The combined rate of infectious and anastomotic complications was 12.2%. There was no significant difference in combined complication rate among those receiving bowel preparation compared with those who did not (14.1% versus 10.5%, P = 0.46). Administration of bowel preparation in the perineal anoplasty subgroup was associated with higher rates of wound infection (33.3% versus 3.3%, P = 0.05). One hundred five patients (58.3%) received perioperative IV antibiotics for ≤24 h. This group had similar rates of complications (13.3%) compared with those receiving IV antibiotics for longer than 24 h (11.6%, P = 0.74).


CONCLUSIONS
Although mechanical bowel preparation did not affect the overall complication rate for pull-through procedures, it was associated with more wound infections in those undergoing perineal anoplasty. Duration of postoperative IV antibiotics was not significantly associated with the rate of wound and anastomotic complications.
['Carpenter|Kyle L|KL|', 'Breckler|Francine D|FD|', 'Gray|Brian W|BW|']
D061605:Administration, Intravenous D000284:Administration, Oral D000293:Adolescent D000900:Anti-Bacterial Agents D019072:Antibiotic Prophylaxis D002400:Cathartics D002648:Child D002675:Child, Preschool D003106:Colon D004065:Digestive System Abnormalities D013505:Digestive System Surgical Procedures D017558:Elective Surgical Procedures D005260:Female D006801:Humans D007223:Infant D008297:Male D011183:Postoperative Complications D017410:Practice Guidelines as Topic D011300:Preoperative Care D012007:Rectum D012189:Retrospective Studies D013997:Time Factors D016896:Treatment Outcome
Pull-through Surgical site infection Anastomotic leak Bowel prep Pediatric colorectal Perioperative antibiotic prophylaxis