Effectiveness of Minimal Bowel Preparation With Oral Bisacodyl Before Laparoscopic Radical Proctectomy: Case-Control Comparison of Bisacodyl and Polyethylene Glycol as Oral Laxative Agents

Abstract

The aim of this study was to evaluate the usefulness of minimal mechanical bowel preparation (MBP) using oral bisacodyl before laparoscopic rectal cancer surgery. Preoperative MBP using conventional oral laxatives in laparoscopic proctectomy may detrimentally affect morbidity and surgical outcomes. Between March 2010 and December 2014, 272 rectal cancer patients who underwent laparoscopic proctectomy were included in the current study. A total of 85 patients undergoing bowel preparation with oral bisacodyl (bisacodyl group) were individually matched to patients receiving polyethylene glycol (PEG group) using propensity score matching. Operative outcomes, morbidity, and mortality were compared between the matched groups. The quality of bowel cleansing was much poorer in the bisacodyl group than in the PEG group (excellent, 43.5% versus 68.2%; fair, 41.2% versus 16.5%; and poor, 15.3% versus 15.3%; P < 0.001). The degree of small bowel distension (collapsed, 56.4% versus 52.9%; mildly distended, 41.2% versus 40.0%; and severely distended, 2.4% versus 7.1%; P = 0.452) and postoperative outcomes, including time to first flatus (3.0 versus 3.0 days, P = 0.426); hospital stay (16.0 versus 15.0 days, P = 0.215); anastomotic leakage rate (8.2% versus 5.9%, P = 0.549); and mortality (0 versus 1.2%, P = 1.000), were similar between the bisacodyl group and the PEG group, respectively. MBP using oral bisacodyl before laparoscopic proctectomy was feasible and safe with respect to morbidity and surgical outcomes. Minimal bowel preparation with bisacodyl seems to be a useful preparation method for laparoscopic proctectomy.