Anastomoses coliques et anti-inflammatoires non-stéroïdiens (AINS)

Nonsteroidal anti-inflammatory drugs (NSAID) play an important role in the treatment of postoperative pain, particularly in the context of enhanced recovery after colorectal surgery. Several recent articles have suggested that NSAID may have a deleterious effect on colo-colic or colorectal anastomoses. The aim of this review is to analyze the evidence based on meta-analyses and cohort studies in the literature. A systematic review of clinical studies identified 12 studies including two meta-analyses and ten comparative cohort studies that included a large number of patients. The data in these studies are heterogeneous, often biased, and do not permit a formal recommendation based on a high level of evidence. The main conclusion of this review is that the balance of benefit vs. risk (analgesic effect/risk of anastomotic disruption) is acceptable; it appears (with a low level of evidence) that a prescription of NSAID for 48 hours after surgery may be recommended for elective colon surgery. Nevertheless, it is important to respect the specific contra-indications of NSAID and avoid postoperative NSAID use if there are risk factors for anastomotic leakage: advanced age, malnutrition, severe comorbidities, intraoperative difficulties.