Preoperative mechanical preparation of the colon: the patient's experience

Abstract

BackgroundPreoperative mechanical bowel preparation can be questioned as standard procedure in colon surgery, based on the result from several randomised trials.MethodsAs part of a large multicenter trial, 105 patients planned for elective colon surgery for cancer, adenoma, or diverticulitis in three hospitals were asked to complete a questionnaire regarding perceived health including experience with bowel preparation. There were 39 questions, each having 3 – 10 answer alternatives, dealing with food intake, pain, discomfort, nausea/vomiting, gas distension, anxiety, tiredness, need of assistance with bowel preparation, and willingness to undergo the procedure again if necessary.Results60 patients received mechanical bowel preparation (MBP) and 45 patients did not (No-MBP). In the MBP group 52% needed assistance with bowel preparation and 30% would consider undergoing the same preoperative procedure again. In the No-MBP group 65 % of the patients were positive to no bowel preparation. There was no significant difference between the two groups with respect to postoperative pain and nausea. On Day 4 (but not on Days 1 and 7 postoperatively) patients in the No-MBP group perceived more discomfort than patients in the MBP group, p = 0.02. Time to intake of fluid and solid food did not differ between the two groups. Bowel emptying occurred significantly earlier in the No-MBP group than in the MBP group, p = 0.03.ConclusionMechanical bowel preparation is distressing for the patient and associated with a prolonged time to first bowel emptying.

Laparoscopic vs. Open Right Hemicolectomies: Short Term Outcomes within an Enhanced Recovery After Surgery Programme

“…All patients in this study received bowel prep, which differs to our ERAS protocol. This can worsen dehydration and prolong post op ileus [32,33]. Our results are similar to Khan et al [34].…”

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

“…The RCTs are awaited to answer this question more accurately. In addition, the intrinsic drawbacks of MBP should be considered such as patients' uncomfortable [41], bacterial translocation [33], and electrolyte disturbance [42].…”

Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS)

“…Mechanical bowel preparation contributes to preoperative dehydration and is unpleasant for the patient. 5,6 Recent evidence suggests that MBP does not decrease anastomotic leakage, wound infection, or mortality (for the majority of patients), 7 and it may even have a tendency towards a higher incidence of spillage of bowel contents due to formed stool being replaced by liquid bowel contents. 8 The patient population in which MBP is indicated is still a matter of debate amongst surgeons, and it is often given for ''handling'' reasons, with some surgeons arguing that MBP facilitates easier laparoscopic surgery.…”