Preoperative mechanical preparation of the colon: the patient's experience

Barbel Jung,Lars Påhlman,Erik Nilsson,Olof Lannerstad,Malin Arodell,Mitra Unosson

doi:10.1186/1471-2482-7-5

Abstract

BackgroundPreoperative mechanical bowel preparation can be questioned as standard procedure in colon surgery, based on the result from several randomised trials.MethodsAs part of a large multicenter trial, 105 patients planned for elective colon surgery for cancer, adenoma, or diverticulitis in three hospitals were asked to complete a questionnaire regarding perceived health including experience with bowel preparation. There were 39 questions, each having 3 – 10 answer alternatives, dealing with food intake, pain, discomfort, nausea/vomiting, gas distension, anxiety, tiredness, need of assistance with bowel preparation, and willingness to undergo the procedure again if necessary.Results60 patients received mechanical bowel preparation (MBP) and 45 patients did not (No-MBP). In the MBP group 52% needed assistance with bowel preparation and 30% would consider undergoing the same preoperative procedure again. In the No-MBP group 65 % of the patients were positive to no bowel preparation. There was no significant difference between the two groups with respect to postoperative pain and nausea. On Day 4 (but not on Days 1 and 7 postoperatively) patients in the No-MBP group perceived more discomfort than patients in the MBP group, p = 0.02. Time to intake of fluid and solid food did not differ between the two groups. Bowel emptying occurred significantly earlier in the No-MBP group than in the MBP group, p = 0.03.ConclusionMechanical bowel preparation is distressing for the patient and associated with a prolonged time to first bowel emptying.

Highlights

Preoperative mechanical bowel preparation can be questioned as standard procedure in colon surgery, based on the result from several randomised trials
BMC Surgery 2007, 7:5 http://www.biomedcentral.com/1471-2482/7/5 multicenter trial performed we found that Mechanical bowel preparation (MBP) did not lower the risk for cardiovascular, general infectious or surgical site complications [13]
MBP was accomplished with sodium phosphate in 28 patients, polyethylene glycol in 31 patients, and enema in one case

Summary

Introduction

Preoperative mechanical bowel preparation can be questioned as standard procedure in colon surgery, based on the result from several randomised trials. Mechanical bowel preparation (MBP) has until recently been thought to be one of the most important factors to decrease infectious complications and prevent anastomotic dehiscence after elective colorectal surgery, but its value has been questioned [1,2]. Several randomised studies [3,4,5,6,7,8,9] and meta-analyses [10,11,12] since the beginning of the 1990's have shown that omission of MBP does not increase the risk for anastomotic dehiscence or septic complications in colon surgery. BMC Surgery 2007, 7:5 http://www.biomedcentral.com/1471-2482/7/5 multicenter trial performed we found that MBP did not lower the risk for cardiovascular, general infectious or surgical site complications [13].

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