Jefferson-University HospitalsBenign and cancerous tumors of the pancreas, common bile duct or duodenum are probably treated by a pancreatico – duodenectomy (PD). Mechanical bowel preparations (MBP), of these patients are usually administered preoperatively. To prevent gastrointestinal surgery, MBPs are possibly used, but their effectiveness in reducing perioperative infectious complications, seems to be unknown. The Department of Surgery at Jefferson Medical College of Thomas Jefferson University appears to find that, MBPs may not be clinically beneficial to patients that undergo a pancreaticoduodenectomy.

The investigators, carried out a contemplative review wherein they examined clinical data from 100 consecutive PDs, performed on the patients who were receiving preoperative MBP, from March 2006 to April 2007. They were compared to 100 consecutive patients, who received a preoperative clear liquid diet (CLD) from May 2007 to March 2008. But, the study authors, failed to find any extreme and important differences between the MBP and CLD groups in the rates of pancreatic fistula, intra-abdominal abscess or wound infection.

However, within the MBP group, a growing trend of increased urinary tract infections and Clostridium difficile infections was noted. In each group, the median length of postoperative hospital stay remained constant for seven days. Also, the 12-month survival rates were equivalent.

Harish Lavu, M.D., assistant professor, Department of Surgery, and lead author of the study remarked, “Based upon these data and similar results from numerous randomized prospective trials in colon and rectal surgery, we feel that patients have improved therapeutic outcomes without MBP prior to PD and we have excluded it from our practice. Given the recent influx of national and institutional quality improvement projects, it is appropriate to define the need and efficacy of MBP for PD if it is to remain in clinical practice.”

In colon surgery, MBP may commonly be thought of as an important factor for avoiding infectious complications and anastomotic dehiscence. MBP is believed, to reduce the volume of solid or semi-solid contents at the time of surgery. This apparently reduces bacterial load, and the risk of intraoperative enteric spillage. Many surgeries that include the gastrointestinal tract, including foregut surgery consider MBP as a standard of care.

To treat benign and malignant disorders of the pancreas and periampullary region, PD surgical procedure is apparently designed. PD is a complex surgical procedure of the upper gastrointestinal tract. Redistribution of the pancreatic head and uncinate process, duodenum, and intra-pancreatic portion of the common bile duct, with reconstruction by the way of anastomotic attachments between the pancreas, biliary tree, and stomach/duodenum to the jejunum is the aim of conducting this operation. This operation is seemingly acknowledged, as a clean contaminated case. The major causes of postoperative morbidity may include pancreatic fistula, intra-abdominal abscess formation, wound infection, urinary tract infection (UTI), and delayed gastric emptying.

Thus, it came to light that MBP is probably not clinically beneficial for patients undergoing pancreaticoduodenectomy.