Is There a Role for Mechanical and Oral Antibiotic Bowel Preparation for Patients Undergoing Minimally Invasive Colorectal Surgery? A Systematic Review and Meta-analysis.

INTRODUCTION: To date, all meta-analyses on oral antibiotic prophylaxis (OA) and mechanical bowel preparation (MBP) in colorectal surgery have included results of both open and minimally invasive approaches. Mixing both procedures may lead to false conclusions. The aim of the study was to assess the available evidence of mechanical and oral antibiotic bowel preparation in reducing the incidence of surgical site infection (SSI) and other complications following minimally invasive elective colorectal surgery. METHODS: We searched PubMed, Science Direct, Google Scholar and Cochrane Library from 2000 to May 1, 2022. Comparative randomized and non-randomized studies were included. We reviewed the use of oral OA, MBP and combinations of these treatments. The methodological quality of the included studies was assessed using the Rob v2 and Robins-I tools. RESULTS: We included 18 studies (7 randomized controlled trials and 11 cohort studies). Meta-analysis of the included studies showed that the combination of MBP + OA was associated with a significant reduction in SSI, AL and overall morbidity compared with the other options no preparation, MBP only and OA only.  CONCLUSION: Adding OA with MBP has a positive impact in reducing the incidence of SSI, AL and overall morbidity after minimally invasive colorectal surgery. Therefore, the combination of OA and MBP should be encouraged in this selected group of patients undergoing minimally invasive surgery.

An unusual localization of echinococcosis: Gallbladder hydatid cyst.

Echinococcosis is endemic in Mediterranean countries. Liver then lungs are the most affected organs. Gallbladder hydatid cyst is an exceptional localization. A 64-year-old patient was referred to our surgical outpatient department by his physician for suspicion of liver hydatid cyst based on right upper quadrant abdominal pain, associated with nausea. Physical examination showed mild tenderness of the right upper quadrant of the abdomen. A computed tomography abdominal scan showed a multivesicular cystic lesion of the segment IV measuring 9.5 × 7.5 × 13 cm with exophytic component abutting the gallbladder. The patient underwent right subcostal laparotomy. The exploration has found that the hydatid cyst is developed from the fundus of the gallbladder, without any connections or fistulas to nearby organs. A cholecystectomy was performed. Histopathological examination confirmed the diagnosis of gallbladder echinococcosis. Primary gallbladder hydatid cysts (PGHC) is an extremely rare condition, occurring in less than 0.4% of echinococcosis localizations. After literature research of case reports, only twenty-three such cases, including our case, have been reported in English literature. Due to its uncommon nature, radiologists rarely consider a PHGB as the first diagnosis. Preoperative diagnosis of hydatid cyst was possible only in 50% of cases. Therefore, a careful attention is necessary to assist in making the diagnosis preoperatively, leading to the appropriate treatment.