Combination oral and mechanical bowel preparations decreases complications in both right and left colectomy

Association of mechanical bowel preparation with oral antibiotics and anastomotic leak following left sided colorectal resection: an international, multi‐centre, prospective audit

“…The majority of data on combined MBP with selective gastrointestinal decontamination with oral antibiotics comes from retrospective analyses of large North American databases. These demonstrate evidence of reduction in anastomotic leak and surgical site infection rates when compared to MBP alone, oral antibiotics alone or no preparation . Evidence from several published clinical trials is consistent with this finding, but randomised evidence remains of low and moderate methodological quality with high risk of bias.…”

“…The most convincing current evidence supporting MBP+Abx is found in retrospective analyses of the large American College of Surgeons’ National Surgical Quality Improvement Program (ACS‐NSQUIP) database. Seven analyses of this dataset have been published to date, including around 147 000 patients . These share common criticisms including the low fidelity of retrospectively collected clerical data, high percentages of missing data fields and a high propensity for selection and reporting bias .…”

“…Seven analyses of this dataset have been published to date, including around 147 000 patients [6][7][8][9][10][11]20]. These share common criticisms including the low fidelity of retrospectively collected clerical data, high percentages of missing data fields and a high propensity for selection and reporting bias [6][7][8][9][10]. When meta-analysis has been performed on these observational datasets a 40% reduction in odds of anastomotic leak has been described [16].…”

The use of oral antibiotics and mechanical bowel preparation in elective colorectal resection for the reduction of surgical site infection

“…The need for an RCT to determine this has long been discussed , because data on OAB alone are contradictory. Different reports show that the use of OAB alone is worse than , equivalent to or better than the MOAB combination in reduction of SSI. The problems are a lack of RCTs that focus on OAB alone in the absence of MBP, small numbers in the OAB alone groups and selection bias in the cohort studies.…”

“…The combination of MOAB in elective colorectal resection is associated with lower rates of SSI. Numerous reports from the North American Surgical Quality Improvement Program (NSQIP) show improved clinical outcomes after varying versions of preoperative MOAB . These observational studies include many thousands of patients undergoing elective surgery and show that the combination of MOAB in comparison to MBP alone is associated with a reduction in SSI of about 50%.…”