title: Rectal enema is an alternative to full mechanical bowel preparation for primary rectal cancer surgery.
abstract: OBJECTIVE
  According to the French GRECCAR III randomized trial, full mechanical bowel preparation (MBP) for rectal surgery decreases the rate of postoperative morbidity, in particular postoperative infectious complications, but MBP is not well tolerated by the patient. The aim of the present study was to determine whether a preoperative rectal enema (RE) might be an alternative to MBP.
  
  
  METHODS
  An analysis was performed of 96 matched cohort patients undergoing rectal resection with primary anastomosis and protective ileostomy at two different university teaching hospitals, whose rectal cancer management was comparable except for the choice of preoperative bowel preparation (MBP or RE). Prospective databases were retrospectively analysed.
  
  
  RESULTS
  Patients were well matched for age, gender, body mass index and Charlson index. The surgical approach and cancer characteristics (level above anal verge, stage and use of neoadjuvant therapy) were comparable between the two groups. Anastomotic leakage occurred in 10% of patients having MBP and in 8% having RE (P = 1.00). Pelvic abscess formation (6% vs 2%, P = 0.63) and wound infection (8% vs 15%, P = 0.55) were also comparable. Extra-abdominal infection (13% vs 13%, P = 1.00) and non-infectious abdominal complications such as ileus and bleeding (27% and 31%, P = 0.83) were not significantly different. Overall morbidity was comparable in the two groups (50% vs 54%, P = 0.83).
  
  
  CONCLUSIONS
  A simple RE before rectal surgery seems not to be associated with more postoperative infectious complications nor a higher overall morbidity than MBP.
authors.affiliation: Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland.
authors.forename: O
authors.initials: O
authors.lastname: Pittet
authors.affiliation: Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Nocito
authors.affiliation: Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: H
authors.initials: H
authors.lastname: Balke
authors.affiliation: Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Duvoisin
authors.affiliation: Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: P A
authors.initials: PA
authors.lastname: Clavien
authors.affiliation: Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland.
authors.forename: N
authors.initials: N
authors.lastname: Demartines
authors.affiliation: Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland.|Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: D
authors.initials: D
authors.lastname: Hahnloser
mesh_terms: D003082:Colectomy / Q000379:methods*; D004733:Enema / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D012004:Rectal Neoplasms / Q000401:mortality / Q000601:surgery*; D012007:Rectum; D015203:Reproducibility of Results; D012189:Retrospective Studies
keywords: Mechanical bowel preparation; bowel preparation; enema; rectal cancer; surgery