title: Colon and rectal surgery without mechanical bowel preparation: a randomized prospective trial.
abstract: 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.
authors.affiliation: Department of Surgery, Sheba Medical Center and Sackler School of Medicine, Tel Aviv, Israel. ozmora@post.tau.ac.il
authors.forename: Oded
authors.initials: O
authors.lastname: Zmora
authors.forename: Ahmad
authors.initials: A
authors.lastname: Mahajna
authors.forename: Barak
authors.initials: B
authors.lastname: Bar-Zakai
authors.forename: Danny
authors.initials: D
authors.lastname: Rosin
authors.forename: Dan
authors.initials: D
authors.lastname: Hershko
authors.forename: Moshe
authors.initials: M
authors.lastname: Shabtai
authors.forename: Michael M
authors.initials: MM
authors.lastname: Krausz
authors.forename: Amram
authors.initials: A
authors.lastname: Ayalon
mesh_terms: 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
chemical_list: D002400:Cathartics; D011092:Polyethylene Glycols