Preoperative Bowel Preparation: Surgical Standard or Past?

Abstract

Background: Preoperative bowel preparation is still routinely used prior to colorectal surgery. This concept is based on traditional and personal empiricism and usually not evidence based. The objective of the present review was to reassess this dogma against the background of the highest level of evidence published thus far. Methods: The Medline database was searched using the search terms ‘preoperative’, ‘bowel’ and ‘preparation’ limited to ‘randomized controlled trials’ and ‘meta-analyses’. Ten randomised controlled trials and seven meta-analyses comparing orthograde bowel cleansing to no preoperative bowel preparation were considered for rates of anastomotic leakages, surgical infections and other types of complications, reoperations and mortality. Results: All the most recent meta-analyses showed a significant increase of anastomotic dehiscences in patients with preoperative orthograde bowel cleansing. Additionally, a trend towards higher rates of surgical infectious complications and re-operations was revealed. Mortality remained unchanged by preoperative orthograde bowel cleansing. Conclusion: Routine preoperative orthograde bowel cleansing is no longer justified prior to colorectal surgery in general due to increased risk of anastomotic leakages. Further investigations should focus on different types of bowel preparation in situations where preoperative bowel preparation still may have a role such as total mesorectal resection with low anastomosis and protective ileostomy.

Mechanical bowel preparation for elective colorectal surgery: updated systematic review and meta-analysis

“…Since 1972, Hughes first challenged the incontrovertible routine of MBP; more and more trials have questioned the hollowed tradition. To date, more than 15 randomized clinical trials [4-6, 17, 18, 21-30, 32, 33] and 10 metaanalyses [7][8][9][10][11][12][13][14][15][16] have been published; results from all the researches were in no favor of MBP and make believed that MBP before elective colorectal surgery can safely be abandoned. Some surgical associations and scientific societies have also updated their guidelines [1].…”

“…Furthermore, several randomized clinical trials have been published to assess the omission of MBP [4][5][6], but the real meaning of MBP is still unclear, especially in laparoscopic colorectal surgery and rectal surgery with low anterior resection. Until now, 10 meta-analyses of randomized clinical trials (RCTs) comparing MBP with no MBP have been published [7][8][9][10][11][12][13][14][15][16]. They concluded that MBP should be omitted since MBP could not reduce infectious postoperative complications and even with higher risk of anastomotic leakage.…”

Perioperative nursing care satisfaction in patients diagnosed with colorectal cancer (CRC)

“…Uvedené údaje potvrdzujú skutočnosť, že klinická prax často nie je založená na dôkazoch, ale je založená na tradícii, osobnej empírii. Müller-Stich a spoluautori [24] tvrdia, že predoperačná ortográdna čistota čriev už nie je opodstatnená v kolorektálnej chirurgii vzhľadom na zvýšené riziko únikov v anastomóze. Bucher et al [25] tvrdia, že existujú obmedzené dôkazy na podporu mechanickej prípravy HČ pred plánovaným operačným zákrokom.…”