Abstract
BackgroundMechanical bowel preparation is routinely done before colon and rectal surgery, aimed at reducing the risk of postoperative infectious complications. The aim of the study was to assess whether elective colon and rectal surgery can be safely performed without preoperative mechanical bowel preparation.MethodsPatients undergoing elective colon and rectal resections with primary anastomosis were prospectively randomized into two groups. Group A had mechanical bowel preparation with polyethylene glycol before surgery, and group B had their surgery without preoperative mechanical bowel preparation. Patients were followed up for 30 days for wound, anastomotic, and intra-abdominal infectious complications.ResultsTwo hundred forty four patients were included in the study, 120 in group A and 124 in group B. Demographic characteristics, type of surgical procedure and type of anastomosis did not significantly differ between the two groups. There was no difference in the rate of surgical infectious complications between the two groups but the overall infectious complications rate was 20.0% in group A and 11.3% in group B (p .05). Wound infection (p = 0.18), anastomotic leak (p = 0.52), and intra-abdominal abscess (p = 0.36) occurred in 9.2%, 5.8%, and 5.0% versus 4.8%, 4.0%, and 2.4%, respectively. No mechanical bowel preparation seems to be safe also in rectal surgery.ConclusionsThese results suggest that elective colon and rectal surgery may be safely performed without mechanical preparation.
Highlights
Mechanical bowel preparation is routinely done before colon and rectal surgery, aimed at reducing the risk of postoperative infectious complications
Mechanical bowel preparation is aimed at cleaning the large bowel of fecal content, there by reducing the rate of infectious complications following surgery
All patients were allowed to have a regular diet until midnight the evening before surgery
Summary
Mechanical bowel preparation is routinely done before colon and rectal surgery, aimed at reducing the risk of postoperative infectious complications. The aim of the study was to assess whether elective colon and rectal surgery can be safely performed without preoperative mechanical bowel preparation. In the first half of the 20th century, mortality from colon and rectal surgery often exceeded 20%, [1] mainly attributed to sepsis. Infectious complications, still are a major cause of morbidity in colorectal surgery, leading to increased cost, prolonged hospital stay, and occasional mortality [2]. Mechanical bowel preparation is aimed at cleaning the large bowel of fecal content, there by reducing the rate of infectious complications following surgery. Bowel cleansing was achieved using enemas in combination with oral laxatives [3].
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