Waheed Akhtar, Farooq Abdullah, Mohammad Imran, Inayat-ur Rehman.
Bowel Preparation Vs No Preparation before Colostomy Closure in Pediatric patients: (A Randomized Prospective Trial in a Tertiary Care Hospital).
Ophthalmol Update Jan ;16(4):900-3.

Objectives: The aim of this study was to determine the difference in outcomes between pediatric patients undergoing preoperative bowel preparation and those with no bowel preparation before colostomy closure. Differences in morbidity and mortality were measured in this study between these two groups. Material and Methods: This is a prospective randomized study. Eighty-five patients undergoing a colostomy reversal were included in this study over the period of two years from August 2015 to July 2017. They were randomly divided into two groups No bowel preparation (NBP) 42 and bowel preparation (BP) 43. Parent`s refusal, any known allergy or contraindication to polyethylene glycol, hepatic, renal or cardiopulmonary abnormality, bleeding diathesis, local skin site infections were excluded from this study. Patients were admitted to the hospital two days before surgery and initiated on intravenous fluids at a weight based maintenance rate. Bowel preparation was started 2 days before surgery with normal saline distal loop wash and Movicol sachet per oral. Patients remained NPO overnight prior to surgery in accordance with anesthesia protocol. All patients received intravenous ceftriaxone and metronidazale - 1 h prior to incision and continued for 3 to 5days post operatively. Postoperatively, surgeon`s judgment dictated the removal of the Naso-gastric tube (NGT) and advancement of diet. Complications or morbidities were noted at the time of discharge. Initial follow up was scheduled in two weeks to OPD. At 4-6 weeks postoperatively the patients were evaluated in OPD to determine postoperative progress and to assess for any complications. Results: Total of 85 patients were included in the study, 42 in No Bowel Preparation group (NBP) and 43 in Bowel Preparation Group (BP). In NBP 10(23.80%) suffered skin infection, 3(7.10%) intra-abdominal abscesses and 2(4.7%) anastomotic leaks while in BP group there were 2(4.7%) patients with skin infection, no intra-abdominal abscess and 2(4.7%) anastomotic leaks. Conclusion: Preoperative bowel preparation is safer and effective before colostomy closure. Large multicentre prospective trials need to be done to establish the significant difference between BP versus NBP.

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