[MOL] Senna vs Polyethylene Glycol for mechanical pre. before elect. col [01202] Medicine On Line

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[MOL] Senna vs Polyethylene Glycol for mechanical pre. before elect. colonic or rectal resection.....

Senna vs Polyethylene Glycol for Mechanical Preparation the Evening Before Elective Colonic or Rectal Resection  
A Multicenter Controlled Trial 
Author Information  Alain Valverde, MD; Jean-Marie Hay, MD; Abe Fingerhut, MD; Marie-Jeanne Boudet, MD; Roberta Petroni, MD; Xavier Pouliquen, MD; Simon Msika, MD; Yves Flamant, MD; for the French Association for Surgical Research

Hypothesis  Senna is more efficient than polyethylene glycol as mechanical preparation before elective colorectal surgery.

Design  Prospective, randomized, single-blind study.

Setting  Multicenter study (18 centers).

Patients  Five hundred twenty-three consecutive patients with colonic or rectal carcinoma or sigmoid diverticular disease, undergoing elective colonic or rectal resection followed by immediate anastomosis.

Intervention  Two hundred sixty-two patients were randomly allotted to receive senna (1 package diluted in a glass of water) and 261 to receive polyethylene glycol (2 packages diluted in 2-3 L of water), administered the evening before surgery. All patients received 5% povidone iodine antiseptic enemas (2 L) the evening and the morning before surgery. Ceftriaxone sodium and metronidazole were given intravenously at anesthetic induction.

Main Outcome Measures  Degree of colonic and rectal cleanliness.

Results  Colonic cleanliness was better (P=.006), fecal matter in the colonic lumen was less fluid (P=.001), and the risk for moderate or large intraoperative fecal soiling was lower (P=.11) with senna. Overall, clinical tolerance did not differ significantly between groups, but 20 patients receiving polyethylene glycol (vs 16 with senna) had to interrupt their preparation, and 15 patients (vs 8 with senna) complained of abdominal distension. Senna, however, was better tolerated (P=.03) in the presence of stenosis. There was no statistically significant difference found in the number of patients with postoperative infective complications (14.7% vs 17.7%) or anastomotic leakage (5.3% vs 5.7%) with senna and polyethylene glycol, respectively.

Conclusion  Mechanical preparation before colonic or rectal resection with senna is better and easier than with polyethylene glycol and should be proposed in patients undergoing colonic or rectal resection, especially patients with stenosis.

Arch Surg. 1999;134:514-519

Author/Article Information

From the Departments of Surgery, H˘pital Louis Mourier, Colombes (Drs Valverde, Hay, Boudet, Msika, and Flamant), Centre Hospitalier Intercommunal, Poissy (Dr Fingerhut), H˘pital Tenon, Paris (Dr Petroni), and H˘pital Victor Dupouy, Argenteuil (Dr Pouliquen), France.
Reprints: Jean-Marie Hay, MD, Associations de Recherche en Chirurgie, 8 Avenue des Peupliers 92270 Bois-Colombes, France. 


Warmly, lillian
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