# Impact of preoperative bowel preparation methods on anastomotic leakage and intestinal motility recovery in laparoscope-assisted heart-shaped anastomosis

## TL;DR

Adding oral antibiotics to mechanical bowel prep before heart-shaped anastomosis surgery reduces infections and speeds recovery in Hirschsprung’s disease patients.

## Contribution

Demonstrates that combining oral antibiotics with mechanical bowel preparation improves surgical outcomes in laparoscope-assisted heart-shaped anastomosis.

## Key findings

- OA + MBP reduced surgical site infections and postoperative length of stay compared to MBP alone.
- OA + MBP improved time to first stool and full feeds, indicating faster intestinal recovery.
- Lower CRP levels on postoperative day five suggest reduced inflammation in the OA + MBP group.

## Abstract

Hirschsprung’s disease (HSCR) is a congenital bowel-obstructive disorder caused by the absence of enteric ganglion cells. While laparoscope-assisted heart-shaped anastomosis (LHSA) shows promise in surgical management, risks like anastomotic leakage persist. Preoperative bowel preparation is key in optimizing surgery outcomes. This study evaluates the efficacy of mechanical bowel preparation (MBP) vs. MBP combined with oral antibiotics (OA) in reducing postoperative complications and improving recovery.

This retrospective cohort study involved 215 HSCR patients who underwent LHSA between June 2010 and June 2023. Patients were divided into two groups: MBP + OA and MBP alone. Outcomes measured included anastomotic leakage, surgical site infections (SSIs), postoperative intestinal motility, inflammatory markers, postoperative recovery markers, and quality of life assessments.

The OA + MBP group demonstrated a significant reduction in SSIs (2.65% vs. 9.80%, P = 0.028) and shorter postoperative LOS (4.20 ± 1.20 days vs. 4.80 ± 1.58 days, P = 0.002). Time to first stool (2.16 ± 0.71 days vs. 2.25 ± 0.72 days, P = 0.004) and full feeds (4.18 ± 1.34 days vs. 4.58 ± 1.36 days, P = 0.029) were improved in the OA + MBP group. On the fifth postoperative day, CRP levels were lower in the OA + MBP group (60.1 ± 19.7 mg/L vs. 67.4 ± 22.5 mg/L, P = 0.012).

The addition of oral antibiotics to mechanical bowel preparation significantly decreases the risk of SSIs, enhances recovery, and improves both inflammatory profiles and bowel function in LHSA.