Nav: Home

Mechanical bowel preparation should not be done before elective colorectal surgery

December 20, 2007

Colorectal surgery can be done safely without mechanical bowel preparation*, and the practice is unnecessary and should be abandoned, according to an Article in this week's issue of The Lancet.

Mechanical bowel preparation is common practice before elective colorectal surgery and is supposed to prevent anastomotic leakage** and septic complications that can cause morbidity and mortality. However, the practice has been shown to have negative side-effects such as bacterial translocation, electrolyte disturbance, and discomfort for patients. Furthermore, recent studies have shown that anastomotic leakage and other infectious complications are more likely to occur in patients who have received mechanical bowel preparation, questioning the need and clinical value of the procedure.

Dr Caroline Contant (Ikazia Hospital, Rotterdam, Netherlands) and colleagues did a multicentre randomised trial of 1431 patients to compare the outcome of elective colorectal resections with and without mechanical bowel preparation. The researchers found that the rate of anastomotic leakage was similar between patients who were given preoperative mechanical bowel preparation and those who were not (4.8% vs 5.4%). However, patients who had mechanical bowel preparation had fewer abscesses after anastomotic leakage than those who did not (0.3% vs 2.5%). Other septic complications, mortality, and length of hospital stay were similar in the two groups.

The authors conclude by calling for an end to the practice of mechanical bowel preparation: "The conclusion that elective colorectal surgery can be safely done without mechanical bowel preparation is justified. In view of the possible disadvantages of this practice, patient discomfort, and the absence of clinical value, we advise that mechanical bowel preparation before elective colorectal surgery should be abandoned."

In an accompanying Comment, Dr Cameron Platell (St John of God Hospital, West Perth, Australia) and Dr John Hall (University of Western Australia, Perth, Australia) say that some doubts still need to be resolved, especially for patients undergoing low rectal anastomoses. They go on: "Although evidence from trials favours not having mechanical bowel preparation, we should consider each case carefully, otherwise the chance of making an inappropriate decision exists with great consequences for patients."
Dr Caroline Contant, Ikazia Hospital, Rotterdam, Netherlands. T) + 31 104 253 532

Comment Dr Cameron Platell, St John of God Hospital, West Perth, Australia.

Notes to editors

*Giving medical purgatives to clean the large bowel.

** Leakage from the surgical connection that joins two parts of the bowel together.View the paper associated with this release here:


Related Colorectal Surgery Articles:

New method for early screening of colorectal cancer
A highly sensitive method that can detect even the earlier stages of colorectal cancer has been developed by researchers in Japan.
Colorectal cancer statistics, 2017
Despite dramatic reductions in overall colorectal cancer incidence and mortality, striking disparities by age, race, and tumor subsite remain
Refusing access to surgery recovery area at a UK hospital unless WHO Safe Surgery Checklist is fully complete
New research showing that refusal to allow surgery teams to take the patient to the recovery room after surgery unless the full WHO Safe Surgery Checklist has been complete is a highly effective way to improve use of the checklist.
Statins and colorectal cancer
A large case-control study published in this week's PLOS Medicine conducted by Ronac Mamtani, M.D., MSCE, an assistant professor of Medicine at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA, and colleagues provides evidence that indication bias may explain the link between statin use and reduced colorectal cancer risk.
Precision prevention of colorectal cancer
In work presented Monday at the American Association for Cancer Research's annual meeting in New Orleans, researchers from Fred Hutchinson Cancer Research Center, the University of Michigan and other research groups debuted their latest progress in precision prevention -- an in-the-works method to predict risk of colorectal cancer that integrates genetic, lifestyle and environmental risk factors.
Ultrasonic surgery reduces pain and swelling after chin surgery
For patients undergoing plastic surgery of the chin (genioplasty), the use of ultrasonic 'piezosurgery' equipment reduces trauma, pain, and swelling, compared to traditional surgical drills, reports a study in the The Journal of Craniofacial Surgery.
Annual plastic surgery statistics reflect the changing face of plastic surgery
The annual plastic surgery procedural statistics from the American Society of Plastic Surgeons (ASPS), show that in 2015 there were 15.9 million surgical and minimally invasive cosmetic procedures performed in the United States -- up 2 percent from 2014.
Enhanced recovery program for colorectal surgery patients can save money for hospitals
The cost of implementing an innovative quality improvement program that helps colorectal surgery patients recover faster is more than offset by savings from their reduced lengths of stay at hospitals of any size.
Meniscus injury: Real surgery or sham surgery -- which is better for patients?
Should the non-surgical approach be preferred over surgical treatment or are there still advantages offered by surgery.
For safer care, simple steps yield substantial improvements in colorectal surgery
Simple steps that include the consistent use of experienced medical teams for a single type of surgery, preemptive antibiotics before the procedure, less reliance on potent opioids during recovery and urging patients to get out of bed and move around sooner can not only prevent infections, blood clots and other serious complications in people undergoing colorectal operations, but can also accelerate recovery and reduce cost of care, according to results of an ongoing program at The Johns Hopkins Hospital.

Related Colorectal Surgery Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Climate Crisis
There's no greater threat to humanity than climate change. What can we do to stop the worst consequences? This hour, TED speakers explore how we can save our planet and whether we can do it in time. Guests include climate activist Greta Thunberg, chemical engineer Jennifer Wilcox, research scientist Sean Davis, food innovator Bruce Friedrich, and psychologist Per Espen Stoknes.
Now Playing: Science for the People

#527 Honey I CRISPR'd the Kids
This week we're coming to you from Awesome Con in Washington, D.C. There, host Bethany Brookshire led a panel of three amazing guests to talk about the promise and perils of CRISPR, and what happens now that CRISPR babies have (maybe?) been born. Featuring science writer Tina Saey, molecular biologist Anne Simon, and bioethicist Alan Regenberg. A Nobel Prize winner argues banning CRISPR babies won’t work Geneticists push for a 5-year global ban on gene-edited babies A CRISPR spin-off causes unintended typos in DNA News of the first gene-edited babies ignited a firestorm The researcher who created CRISPR twins defends...