Colon and rectal surgery without mechanical bowel preparation: a randomized prospective trial.
OBJECTIVE
To assess whether elective colon and rectal surgery can be safely performed without preoperative mechanical bowel preparation.


BACKGROUND
Mechanical bowel preparation is routinely done before colon and rectal surgery, aimed at reducing the risk of postoperative infectious complications. However, in cases of penetrating colon trauma, primary colonic anastomosis has proven to be safe even though the bowel is not prepared.


METHODS
Patients 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.


RESULTS
Three hundred eighty patients were included in the study, 187 in group A and 193 in group B. Demographic characteristics, indications for surgery, and type of surgical procedure did not significantly differ between the two groups. Colo-colonic or colorectal anastomosis was performed in 63% of the patients in group A and 66% in group B. There was no difference in the rate of surgical infectious complications between the two groups. The overall infectious complications rate was 10.2% in group A and 8.8% in group B. Wound infection, anastomotic leak, and intra-abdominal abscess occurred in 6.4%, 3.7%, and 1.1% versus 5.7%, 2.1%, and 1%, respectively.


CONCLUSIONS
These results suggest that elective colon and rectal surgery may be safely performed without mechanical preparation.
Zmora
Oded
O
Department of Surgery, Sheba Medical Center and Sackler School of Medicine, Tel Aviv, Israel. ozmora@post.tau.ac.il
Mahajna
Ahmad
A
Bar-Zakai
Barak
B
Rosin
Danny
D
Hershko
Dan
D
Shabtai
Moshe
M
Krausz
Michael M
MM
Ayalon
Amram
A
D018784:Abdominal Abscess / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D019072:Antibiotic Prophylaxis; D002400:Cathartics / Q000008:administration & dosage*; D003106:Colon / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D011183:Postoperative Complications; D011300:Preoperative Care; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery*; D013530:Surgical Wound Infection
D002400:Cathartics; D011092:Polyethylene Glycols