Preparation with Mechanical Bowel Cleansing or/and Oral Antibiotics or Nothing for Elective Colorectal Surgery: Two-Two-Arm Multicentre Randomised Controlled Studies (MECCLANT –C and –R Trials)

During almost all the 20^th century and practically based on observational studies and experts opinion, mechanical bowel preparation (MBP) has been considered as necessary prior to colorectal surgery, in order to remove gross faecal and bacteria colonic load and thus to prevent anastomotic leakage and reduce septic postoperative complications. 

However, several more recent randomised clinical trials, meta-analyses, systematic reviews and surveys have consistently shown that MBP does not prevent either anastomotic leakage or surgical site infection (SSI), and does not reduce immediate postoperative morbidity or. Furthermore, MBP is costly, time consuming, harmful and unpleasant for the patient, and also impedes implementation of enhanced recovery programmes. As a result of the aforementioned evidence,it is recommended that MBP for colorectal surgery must be abandoned.(Read more)

Dysphagia Rehabilitation Journal

Swallowing function declines due to anatomical and physiological changes that accompany aging. In addition, dysphagia can be caused by numerous disorders. In patients with acute stroke, deglutition disorders are observed at a frequency of 37-78%, and can be fatal if aspiration pneumonia or suffocation occurs. More than 90% of patients who die of pneumonia are elderly, aged 65 years or older, and the most common cause is aspiration pneumonia due to dysphagia.

Silent aspiration (SA), which has no signs or symptoms, such as coughing, when saliva or food enter the subglottis, oropharyngeal aspiration is an important etiologic factor leading to pneumonia in the elderly. Video-fluorography (VF) or video-endoscopy (VE), which can indicate SA, are useful in diagnosing dysphagia and are performed routinely in facilities specializing in dysphagia rehabilitation. In facilities that do not have the necessary equipment for VF or VE, or under circumstances where the patients cannot be referred to a testing facility, the evaluation of dysphagia is performed using a variety of screening tests that can be performed at the bedside. These screening tests include the water swallowing test and the food test, and many of these tests assess the presence or absence of coughing to diagnose aspiration and swallowing dysfunction. Unfortunately, dysphagia with laryngopharyngeal sensory dysfunction is difficult to detect using these tests. Therefore, an accurate screening test for silent aspiration and dysphagia with laryngopharyngeal sensory dysfunction is needed.