title: Laparoscopic colectomy without mechanical bowel preparation.
abstract: BACKGROUND
  Mechanical bowel preparation prior to colorectal surgery may reduce infectious complications, facilitate tumor localization, and allow intraoperative colonoscopy, if required. However, recent data suggest that mechanical bowel preparation may not facilitate a reduction in infectious complications. During laparoscopic colectomy, manual palpation is blunt, thereby potentially compromising tumor localization. The aim of this study was to assess the utility of mechanical bowel preparation in laparoscopic colectomy.
  
  
  METHODS
  A retrospective medical record review of all patients who underwent laparoscopic colectomy was performed. Patients were divided into two groups: those who had preoperative mechanical bowel preparation (Group A) or those who did not (Group B). All relevant perioperative data were reviewed and compared.
  
  
  RESULTS
  Two hundred patients underwent laparoscopic colectomy; 68 (34%) were in Group A and 132 (66%) were in Group B. Sixteen (8%) patients required intraoperative colonoscopy for localization and were evenly distributed between the two groups. The incidence of conversion to laparotomy was slightly higher in Group B (14 vs 9%) due to difficult localization in some cases; however, this difference did not reach statistical significance. Furthermore, there was no significant difference in the postoperative complication rate between the two groups. Specifically, an anastomotic leak and a wound infection were recorded in 4 and 12% of patients in Group A compared to 3 and 17% in Group B, respectively.
  
  
  CONCLUSIONS
  Laparoscopic colectomy may be safely performed without preoperative mechanical bowel preparation, although difficult localization may lead to a slightly higher conversion rate. Appropriate patient selection for laparoscopic colectomy without mechanical bowel preparation is essential. Furthermore, bowel preparation should be considered in cases of small and nonpalpable lesions.
authors.affiliation: Department of Surgery and Transplantation, Sheba Medical Center, Sackler School of Medicine, Tel-Hashomer, 52621, Tel-Aviv, Israel. ozmora@post.tau.ac.il
authors.forename: Oded
authors.initials: O
authors.lastname: Zmora
authors.forename: Alexander
authors.initials: A
authors.lastname: Lebedyev
authors.forename: Aviad
authors.initials: A
authors.lastname: Hoffman
authors.forename: Marat
authors.initials: M
authors.lastname: Khaikin
authors.forename: Yaron
authors.initials: Y
authors.lastname: Munz
authors.forename: Moshe
authors.initials: M
authors.lastname: Shabtai
authors.forename: Amram
authors.initials: A
authors.lastname: Ayalon
authors.forename: Danny
authors.initials: D
authors.lastname: Rosin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods*; D003710:Demography; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications