A Review of Bowel Preparation Before Colorectal Surgery

Abstract

Some patients who have undergone preoperative chemoradiotherapy (CRT) following surgery have been diagnosed with late recurrence more than 5 years after treatment, raising questions about the possible benefit extending surveillance beyond the recommended 5 years. In 2011, a 71-year-old male was diagnosed with T3N+ low-lying rectal cancer located 3 cm from the anal verge before undergoing long-course preoperative CRT. After CRT, the patient was reexamined and diagnosed with ycT1-2N0 lesion, so local excision(LE) was performed. The patient underwent intensive surveillance for up to 5 years, and no evidence of recurrence was found. At 74 months after surgery, the patient was hospitalized for a hematochezia, and local recurrence at the excision site and peritoneal seeding nodules were identified. Considering the late recurrence in this patient, it might be necessary to long-term follow-up beyond 5 years in patients with preoperative CRT followed by LE.

Bowel Endometriosis Management by Colorectal Resection: Laparoscopic Surgical Technique & Outcome

“…The commonly followed regime for bowel preparation, recommended by various medical societies, is the use of mechanical bowel preparation (MBP) combined with pre-operative oral antibiotics. 17 , 18 Few studies have advocated the noninferiority of intravenous preoperative antimicrobial prophylaxis compared to combined pre-operative oral and intravenous antibiotic prophylaxis. 19 The ideal antibiotic regimen has not yet been confirmed.…”

A prospective, randomized assessment of a novel, local antibiotic releasing platform for the prevention of superficial and deep surgical site infections

“…While many surgeries requiring abdominal soft-tissue incisions such as urologic, gynecologic, and hepatobiliary procedures rely solely on intravenous antibiotics for systemic prophylaxis, the perceived rationale for inclusion of OABP and MBP in colorectal surgery is to reduce the potential soft-tissue wound contamination from bacteria originating in the lumen of the manipulated open bowel during the operative procedure [ 11 – 15 ]. Multiple clinical studies and meta-analyses have shown that MBP alone does not reduce the incidence of superficial or deep SSIs, and much of the recent literature seems to coalesce on the use of oral antibiotic prophylaxis in combination with intravenous antibiotic prophylaxis and/or mechanical bowel preparation [ 11 , 16 – 20 ]. Despite this, there are still studies which conclude that there is no difference in outcomes with bowel preparation compared to no bowel preparation [ 15 ], even while there is ongoing disagreement on the most appropriate OABP regimen [ 16 ] and many developed countries do not routinely include OABP [ 21 ].…”

“…Multiple clinical studies and meta-analyses have shown that MBP alone does not reduce the incidence of superficial or deep SSIs, and much of the recent literature seems to coalesce on the use of oral antibiotic prophylaxis in combination with intravenous antibiotic prophylaxis and/or mechanical bowel preparation [ 11 , 16 – 20 ]. Despite this, there are still studies which conclude that there is no difference in outcomes with bowel preparation compared to no bowel preparation [ 15 ], even while there is ongoing disagreement on the most appropriate OABP regimen [ 16 ] and many developed countries do not routinely include OABP [ 21 ]. Given the debate, the data presented here may offer guidance on the potential role for D-PLEX in cases where bowel preparation is contraindicated, procedures for Class 2, 3, or 4 wounds, or in cases of unanticipated bowel resection to improve SSI prophylaxis in soft-tissue (myofascial layer, subcutaneous fat, and skin) incisions.…”

The Impact of the Enhanced Recovery After Surgery (ERAS) Protocol on Colorectal Surgery in a Portuguese Tertiary Hospital

“…16 The ERAS ® Society does not recommend bowel preparation as a routine on colorectal surgery, but it is still controversial depending on the location of the lesion and the surgical approach. 17 Some studies suggested that preparation is linked to adverse effects such as prolonged ileus and patient distress without any evidence of advantages and should not be used routinely. 18 The analysis of some studies showed that the ERAS pathway was associated with a reduction of morbidity, particularly associated with a reduced number of surgical complications.…”