Bowel preparation with oral antibiotics for elective colorectal surgery: back to the future?

Abstract

There is controversy regarding the use of preoperative mechanical bowel preparation (MBP) before elective colorectal surgery. Factual data have led many European learned societies not to recommend MBP whereas its use remains widespread among US surgeons. This review was assessed to clarify the role of preoperative MBP and oral antibiotics. We searched PubMed, Embase, and the Cochrane Library for relevant literature. Search terms included preoperative bowel preparation, oral antibiotics, colorectal surgery and postoperative morbidity. MBP combined with oral antibiotics before elective colorectal surgery remains a present subject of debate within the surgical community. Over a century ago, MBP was considered, dogmatically, as a standard surgical practice. But, the gradual spread of minimally invasive surgery as laparoscopy in colorectal procedures added to enhanced recovery after surgery (ERAS) program promoted its abandonment. Therefore, several large retrospective studies recently questioned the abandonment of MBP suggesting that its omission was deleterious in terms of surgical sites infection (SSI) and anastomotic leakage, especially when MBP was combined with oral antibiotics.