title: Mechanical bowel preparation for colorectal surgery.
abstract: BACKGROUND
  Nosocomial infections are the most frequent complications of surgical patients. Most surgical site infections (SSI) are acquired intraoperatively and arise from the flora of the patient's skin, gastrointestinal tract, or mucous membranes. Although preoperative mechanical cleansing of the bowel is considered by many surgeons a cornerstone of modern elective colorectal surgery and, in association with antibiotic prophylaxis, a fundamental component of an intestinal antisepsis program, many surgeons do not perform preoperative mechanical preparation routinely.
  
  
  METHODS
  Review of the pertinent literature.
  
  
  RESULTS
  Some recent randomized trials and a Cochrane review found no proof that mechanical bowel preparation reduces the risk of complications after elective colorectal surgery. Indeed, there is some evidence that this intervention is associated with a higher rate of anastomotic leakage and wound complications.
  
  
  CONCLUSIONS
  The dogma that mechanical bowel preparation is necessary before elective colorectal surgery may need to be reconsidered. On the other hand, such preparation decreases operating time by improving bowel handling during construction of the anastomosis. Moreover, it is helpful when intestinal palpation will be necessary for identification of a lesion.
authors.affiliation: Department of Surgical Sciences, University of Insubria, Varese, Italy. Francesca.rovera@uninsubria.it
authors.forename: Francesca
authors.initials: F
authors.lastname: Rovera
authors.forename: Gianlorenzo
authors.initials: G
authors.lastname: Dionigi
authors.forename: Luigi
authors.initials: L
authors.lastname: Boni
authors.forename: Alberta
authors.initials: A
authors.lastname: Ferrari
authors.forename: Veronica
authors.initials: V
authors.lastname: Bianchi
authors.forename: Mario
authors.initials: M
authors.lastname: Diurni
authors.forename: Giulio
authors.initials: G
authors.lastname: Carcano
authors.forename: Renzo
authors.initials: R
authors.lastname: Dionigi
mesh_terms: D019072:Antibiotic Prophylaxis; D002400:Cathartics / Q000008:administration & dosage*; D003107:Colorectal Surgery; D006801:Humans; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D013530:Surgical Wound Infection / Q000517:prevention & control*; D007507:Therapeutic Irrigation / Q000379:methods*
chemical_list: D002400:Cathartics