How are perioperative complications of colon resection (colectomy) prevented?

Updated: Apr 05, 2021
  • Author: David E Stein, MD, MHCM; Chief Editor: Vikram Kate, FRCS, MS, MBBS, PhD, FACS, FACG, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS, FFST(Ed)  more...
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Answer

Perioperative complications due to colon resections may include wound infection, pelvic abscess formation, anastomotic leakage, bleeding, or injury to other organs/structures. The surgical-site infection (SSI) rate at the authors’ institution as per the National Surgical Quality Improvement Program for colon resections is 6%, and the anastomotic leak rate is 2%. The incidence in the literature ranges from 4% to 38%. The rate of the other complications is less than 2%.

To prevent complications, prophylactic antibiotics should be administered within 30 minutes of incision. Suggested antibiotic regimens for colectomy include the following:

  • Cefazolin 1 or 2 g plus metronidazole 500 mg
  • Ertapenem injection 1 g
  • Levofloxacin 500 mg plus metronidazole 500 mg (if the patient is allergic to penicillin)

In addition, the authors prescribe a Nichol preparation the night before surgery, which consists of an erythromycin base and neomycin (1 g each at 5:00 PM, 6:00 PM, and 9:00 PM). Mechanical bowel preparation is used for left, sigmoid, and rectal resections.

To reduce the risk of infection after surgery, the authors irrigate the rectum with dilute povidone-iodine before performing left and sigmoid colectomies, as well as proctectomies. [16]

To prevent deep venous thrombosis (DVT), all patients should have sequential compression devices and receive heparin or low-molecular-weight heparin (LMWH) subcutaneously within 2 hours of surgery.


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