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."
-end-
Dr Caroline Contant, Ikazia Hospital, Rotterdam, Netherlands. brusselcontant@chello.nl T) + 31 104 253 532

Comment Dr Cameron Platell, St John of God Hospital, West Perth, Australia. cplatell@cyllene.uwa.edu.au

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: http://multimedia.thelancet.com/pdf/press/Bowel.pdf

Lancet

Related Colorectal Surgery Articles from Brightsurf:

Decision conflict before cancer surgery correlates with lower activity after surgery
Nearly one-third of cancer patients who decide to undergo surgery for their condition may have second thoughts, and this decision conflict may lead to less favorable treatment outcomes in both the near- and long-term, according to a team of investigators at Massachusetts General Hospital and Ariadne Labs.

Examining association between weight loss before bariatric surgery, risk of death after surgery
Researchers looked at whether a patient's body weight and weight loss before bariatric surgery were associated with risk of death within 30 days after surgery using data from nearly 500,000 patients in the US and Canada.

Comparing risk of colorectal cancer after weight-loss surgery
Researchers used French electronic health data to investigate how risk of colorectal cancer compared among obese adults who had weight-loss surgery and who didn't.

Guidelines for thyroid surgery published in Annals of Surgery
The first set of comprehensive, evidence-based clinical guidelines for surgical treatment of thyroid disease -- developed by an expert panel assembled by the American Association of Endocrine Surgeons (AAES) -- was published today by Annals of Surgery.

Weight loss surgery may reduce the risk of colorectal cancer
Weight loss surgery may reduce the risk of developing colorectal cancer by one-third, according to an analysis of all relevant published studies.

Does weight loss surgery affect colorectal cancer risk?
Although colorectal cancer is associated with obesity, it is unclear if weight loss surgery impacts the incidence of these tumors.

Colorectal surgery patients use fewer opioids, report less pain with enhanced recovery after surgery
Colorectal surgery patients who were a part of an enhanced recovery after surgery (ERAS) program had less pain, while using nearly half as many opioids, according to research being presented at the ANESTHESIOLOGY® 2019 annual meeting.

Video assisted lung surgery reduces complications and hospital stays compared to open surgery
Video-assisted thoracic surgery is associated with lower in-hospital complications and shorter length of stay compared with open surgery among British patients who were diagnosed at an early stage of lung cancer, according to research presented today the IASLC 2019 World Conference on Lung Cancer, hosted by the International Association for the Study of Lung Cancer.

Most deaths related to noncardiac surgery occur after surgery and after discharge from hospital
It's not the operating room that is risky for patients undergoing noncardiac surgery; it's the recovery period.

Children requiring thyroid surgery have better outcomes at high-volume surgery centers
New research recently published in the Journal of Pediatric Surgery found that post-operative success rates of pediatric thyroid patients, particularly children who require a thyroidectomy, correlate with the institution's patient volume.

Read More: Colorectal Surgery News and Colorectal Surgery Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.