Preoperative bowel preparation: surgical standard or past?
BACKGROUND
Preoperative bowel preparation is still routinely used prior to colorectal surgery. This concept is based on traditional and personal empiricism and usually not evidence based. The objective of the present review was to reassess this dogma against the background of the highest level of evidence published thus far.


METHODS
The Medline database was searched using the search terms 'preoperative', 'bowel' and 'preparation' limited to 'randomized controlled trials' and 'meta-analyses'. Ten randomised controlled trials and seven meta-analyses comparing orthograde bowel cleansing to no preoperative bowel preparation were considered for rates of anastomotic leakages, surgical infections and other types of complications, reoperations and mortality.


RESULTS
All the most recent meta-analyses showed a significant increase of anastomotic dehiscences in patients with preoperative orthograde bowel cleansing. Additionally, a trend towards higher rates of surgical infectious complications and re-operations was revealed. Mortality remained unchanged by preoperative orthograde bowel cleansing.


CONCLUSIONS
Routine preoperative orthograde bowel cleansing is no longer justified prior to colorectal surgery in general due to increased risk of anastomotic leakages. Further investigations should focus on different types of bowel preparation in situations where preoperative bowel preparation still may have a role such as total mesorectal resection with low anastomosis and protective ileostomy.
Muller-Stich
Beat P
BP
Department of General, Abdominal and Transplant Surgery, University of Heidelberg, Heidelberg, Germany.
Choudhry
Arash
A
Vetter
Gregor
G
Antolovic
Dalibor
D
Mehrabi
Arianeb
A
Köninger
Jörg
J
Weitz
Jürgen
J
Büchler
Markus W
MW
Gutt
Carsten N
CN
D002400:Cathartics / Q000008:administration & dosage; D003107:Colorectal Surgery; D006801:Humans; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D012086:Reoperation; D013529:Surgical Wound Dehiscence / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000517:prevention & control; D007507:Therapeutic Irrigation / Q000379:methods
D002400:Cathartics