Colon and rectal surgery for cancer without mechanical bowel preparation: one-center randomized prospective trial.
BACKGROUND
Mechanical bowel preparation is routinely done before colon and rectal surgery, aimed at reducing the risk of postoperative infectious complications. The aim of the study was to assess whether elective colon and rectal surgery can be safely performed without preoperative mechanical bowel preparation.


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
Two hundred forty four patients were included in the study, 120 in group A and 124 in group B. Demographic characteristics, type of surgical procedure and type of anastomosis did not significantly differ between the two groups. There was no difference in the rate of surgical infectious complications between the two groups but the overall infectious complications rate was 20.0% in group A and 11.3% in group B (p .05). Wound infection (p = 0.18), anastomotic leak (p = 0.52), and intra-abdominal abscess (p = 0.36) occurred in 9.2%, 5.8%, and 5.0% versus 4.8%, 4.0%, and 2.4%, respectively. No mechanical bowel preparation seems to be safe also in rectal surgery.


CONCLUSIONS
These results suggest that elective colon and rectal surgery may be safely performed without mechanical preparation.
Scabini
Stefano
S
Unit of Surgical Oncology, Department of Emato-Oncology, San Martino Hospital, Genoa, Italy. stefanoscabini@libero.it
Rimini
Edoardo
E
Romairone
Emanuele
E
Scordamaglia
Renato
R
Damiani
Giampiero
G
Pertile
Davide
D
Ferrando
Valter
V
D000368:Aged; D000714:Anastomosis, Surgical; D003110:Colonic Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011092:Polyethylene Glycols / Q000008:administration & dosage; D011183:Postoperative Complications; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*; D013501:Surface-Active Agents / Q000008:administration & dosage; D013530:Surgical Wound Infection; D015996:Survival Rate; D016896:Treatment Outcome
D013501:Surface-Active Agents; D011092:Polyethylene Glycols