Do we need Bowel Prep
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- Mechanical bowel prep alone increases infection rates and hospital length of stay in pediatric patients undergoing colostomy takedown.
- Adult data shows mechanical bowel prep provides no benefit or causes harm; oral non-absorbable antibiotics may help in adults.
- Pediatric studies demonstrate no benefit from mechanical bowel prep with or without oral antibiotics for colostomy reversal.
- Current evidence supports omitting both mechanical bowel prep and oral antibiotics in pediatric colostomy takedown procedures.
- Two pediatric studies consistently show no advantage to bowel preparation, supporting a no-prep approach for this patient population.
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So, today I have a patient that I'm scheduling for surgery. She has a colostomy, I'm doing a colostomy takedown. And I wanted to know what is the new, what is the new standard of care for colostomy takedowns in bowel preps? What does the literature say in this day and age about how we should be managing these patients? So, I asked my fellow Ian Glenn, who is a my research fellow, he's a general surgery resident at the Cleveland Clinic, and he's doing research here at Akron Children's. What's the data say about this? That's a good question, Todd. You know, if you look at the adult literature, there's pretty good prospective randomized trials that show that mechanical bowel prep alone in adults is doing them no good or probably harming them. And oral antibiotics that aren't absorbed are probably a good idea. In kids, there's two good studies. One study showed that mechanical bowel prep by itself led to a higher rate of infection and longer hospital stays in kids, and addition of antibiotics didn't make any difference. And then there was another study that showed that mechanical bowel prep and oral antibiotics didn't make a difference at all between the two groups. So I think for your patient, it probably makes sense to not do either one. Nothing. Correct. No mechanical, no oral antibiotics. Yep, exactly. All right, there you go.