Colon Lavage Preparatons

Still?

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More than 3 decades ago, bowel surgery was the scourge of medicine. Folks undergoing such procedures were pretty much assured they would develop complications due to infection. Those infection rates were well upwards of 90%! The death rate was pretty high, too. Of course, not operating on these folks guaranteed the patients almost certain death.

Then, the development of a colon electrolyte lavage solution changed these numbers. For non-emergency surgery, patients could undergo a 3 to 4 hour “cleanse”, which would literally clean their bowels. Whether one used Colyte or Golytely (these are virtually identical preparations), the iso-osmotic, isotonic solution left the gastrointestinal system bereft of contamination- solids and microbes.

Colon Lavage Preparatons

But, that solution was provided to those undergoing elective bowel surgery,  not for emergency situations.  Colon lavage  would be difficult for emergency operations performed almost immediately after patient arrival at the hospital. But, as opposed to what you see on TV, the general definition of emergency does not mean immediate surgery, but still it was thought there was insufficient time for gastrointestinal cleaning.

Now, three decades later, there still is no major improvement for this situation. As Drs. Joaquim Havens, Olubode Olufajo, Zara Cooper, Adil Haider, Adil Shah, and Ali Salim (all from Brigham/Women’s Hospital of Harvard University in Boston) reported in JAMA (Journal of the American Medical Association) Surgery just the other day in their paper “Defining Rates and Risk Factors for Readmissions Following Emergency General Surgery”.

The researchers examined hospital inpatient data from across the US (421,476 patients) over the years 2008 through 2011. The data demonstrated that 80% of all admissions in seven (7) procedures resulted in complications (15% of all operations, death rate of 1.2%). (They also entailed a high proportion of the in-patient costs- to the tune of $13,241 on average.)

Not surprising, these dangerous and expensive emergency surgeries were related to the digestive system- basically those operations that open the abdomen. In particular, removing part of the colon, bowel resections, treatment of peptic ulcers, and abdominal adhesion removal were among the worst situations found by Havens et. al. Gall bladder removal and appendectomies were less problematic; however, their sheer numbers (each of those operations has a census of some 600K annually) meant that small negative outcomes are still a large number.

It should be noted that the researchers were only examining “general” surgery procedures. As such, heart-related procedures and treatment of trauma (car crashes, etc.) were excluded from the analysis. Even so, some 3 million Americans undergo emergency general surgery every year.

However, most of these surgeries involved operations within 2 days of admission. (I am sure most of you considered emergency bowel surgery would be immediately effected when the patient arrives at the hospital. As you can see, that is not generally the case.) And, it’s obvious that emergency surgery is riskier than elective surgery. But, to have a death rate 8 times that of elective surgery (for the same procedures) is a pretty negative potential outcome.

Obviously, if the patient is suffering from bowel obstruction, the administration of a colon lavage preparation could be deadly. (There is no place for discharge of the ingested solutons.) Those suffering from gastrointestinal bleeding may not be able to withstand the procedure. Severe infections, however, should not preclude colon lavage; the procedure may actually provide a major component of the treatment protocol.

Given those considerations, the use of Colyte and Golytely could be administered (for non-blockage situations). Perhaps this should become a prophylactic for all these patients complaining of bowel symptoms.

After all, that is exactly why these drugs were developed. (Although they rendered the newer [since the mid-1980s] procedures of colonoscopy and endoscopy possible.)

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9 thoughts on “Still?”

  1. This is something that I, as a layperson, never thought of. Although, with Golyghtly, which I’ve used three times now, seemed like it took more than four hours. But that’s a small quibble.

    1. Golytely and/or Colyte effect the cleansing of the colon in four hours (sometimes in 3). Of course, it may take some folks longer to ingest the 3 to 4 liters of the concoction, which will change the results.
      3 times, huh, Alana… That’s a “healthy” dose.

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