title: Morphologic alterations associated with mechanical bowel preparation before elective colorectal surgery: a randomized trial.
abstract: OBJECTIVE
  The feasibility and safety of left-sided colorectal procedures with avoidance of mechanical bowel preparation has recently been demonstrated. Moreover, mechanical preparation has been associated with an increased risk for abdominal septic complications, including anastomotic leakage. This study was designed to determine whether mechanical bowel preparation is associated with histologic alterations in the colon.
  
  
  METHODS
  Fifty patients (mean age, 61 (range, 45-78) years) scheduled to undergo elective colorectal surgery were prospectively randomized to receive mechanical preparation (polyethylene glycol; Group 1) or no preparation (Group 2) preoperatively. A macroscopically healthy segment of the bowel was excised at the proximal margin of the colectomy piece. A pathologist, blinded to the patient's group allocation, assessed various morphologic parameters.
  
  
  RESULTS
  Indications for colectomy (cancer and complicated diverticulosis) did not differ between groups. Bowel wall alterations were more frequent in patients who received a preparation. The most striking alterations associated with mechanical preparation were loss of superficial mucus (moderate-to-severe in 96 and 52 percent in Groups 1 and 2, respectively; P < 0.001) and epithelial cells (moderate-to-severe in 88 and 40 percent in Groups 1 and 2, respectively; P < 0.01). In addition, inflammatory changes, i.e., lymphocytes (severe in 48 and 12 percent in Groups 1 and 2, respectively; P < 0.02) and polymorphonuclear cells infiltration (severe in 52 and 8 percent in Groups 1 and 2, respectively; P < 0.02), were more prevalent after mechanical preparation.
  
  
  CONCLUSIONS
  Mechanical bowel preparation is associated with structural alteration and inflammatory changes in the large bowel wall. Although bowel wall inflammation is a known risk factor for anastomotic leak, it remains to be elucidated whether these changes have a direct relation to the deleterious effect of mechanical bowel preparation in terms of abdominal morbidity.
authors.affiliation: Department of Surgery, Clinic of Visceral and Transplantation Surgery, Geneva, Switzerland. Pascal.Bucher@hcuge.ch
authors.forename: Pascal
authors.initials: P
authors.lastname: Bucher
authors.forename: Pascal
authors.initials: P
authors.lastname: Gervaz
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Egger
authors.forename: Claudio
authors.initials: C
authors.lastname: Soravia
authors.forename: Philippe
authors.initials: P
authors.lastname: Morel
mesh_terms: D000368:Aged; D003082:Colectomy; D003108:Colonic Diseases / Q000473:pathology / Q000601:surgery*; D017558:Elective Surgical Procedures; D004733:Enema; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000473:pathology; D007420:Intestine, Large / Q000473:pathology*; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome