The Role of Bowel Preparation in Colorectal Surgery

Abstract

Combined MBP/ABP results in significantly lower rates of SSI, organ space infection, wound dehiscence, and anastomotic leak than no preparation and a lower rate of SSI than ABP alone. Combined bowel preparation significantly reduces the rates of infectious complications in colon and rectal procedures without increased risk of Clostridium difficile infection. For patients undergoing elective colon or rectal resection we recommend bowel preparation with both mechanical agents and oral antibiotics whenever feasible.

Effect of preoperative oral antibiotics in combination with mechanical bowel preparation on inflammatory response and short‐term outcomes following left‐sided colonic and rectal resections

“…It seems unlikely that this discrepancy would have had a significant effect on short‐term outcomes. There was no statistically significant reduction in deep SSI or anastomotic leak rates, as reported in some larger studies. It seems likely that this reflected relatively low rates of these complications that this study was not powered to detect.…”

“…Current literature reports minimal adverse events with this intervention. One RCT reported increased nausea and vomiting in patients receiving three preoperative doses of oral antibiotics compared with that in patients receiving either one dose or no antibiotics ( P < 0·001), although other trials have reported no negative effects of additional oral antibiotics in terms of enteritis, colitis and/or diarrhoea, including Clostridium difficile infection.…”

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

“…The majority of studies show no differences in CDI rates in patients exposed to OAB. This holds true for retrospective studies , RCTs and in meta‐analysis . There is no evidence of harm in terms of increase in CDI rates by using MOAB.…”

“…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%.…”