Effect of mechanical bowel preparation with antibiotics and probiotics on postoperative ileus in patients undergoing posterior lumbar spine surgeries: a randomized controlled trial

Abstract

Study design: Randomized controlled trial (RCT).

Purpose: This study aimed to determine the impact of mechanical bowel preparation (MBP) before surgery on postoperative ileus (POI) after elective lumbar spine procedures conducted via a posterior approach.

Overview of literature: Postoperative Ileus occurs in 5%-12% of spine surgeries. The data relating to spine surgeries is sparse. Previous studies have not shown a significant effect of MBP. However, most of these studies have been conducted on patients undergoing spine surgeries through anterior approaches.

Methods: This RCT included 60 patients (30 in control and 30 in intervention) between 18 and 80 years old, scheduled for elective single or double-level lumbar spine surgeries through the posterior approach. Intervention group (MBP) received PEGLEC, tablet Metronidazole 400 mg twice daily (BD), tablet Cefuroxime 500 mg BD, and probiotic (Bacillus clausii ) on pre-operation day, whereas the control (non-MBP) had no specific bowel preparation but received only a placebo. Outcome parameters included time to first flatus, bowel sound, and first defecation, which were compared between the two groups.

Results: Demographic data such as age, sex, body mass index, level of surgery, and intraoperative data such as duration of surgery and blood loss were similar without significant differences. The time to first flatus, bowel sounds, and first defecation was not statistically significant, but POI was seen in 6.67% of patients, all belonging to the MBP group. No correlation observed between the duration of the ileus and the intraoperative blood loss and duration of surgery.

Conclusions: Bowel preparation may not be necessary for patients undergoing posterior lumbar spine surgery involving a maximum of two levels.

Keywords: Antibiotics; Bowel; Ileus; Probiotics; Spine.