Benefit of mechanical bowel preparation prior to elective colorectal surgery: current insights.
BACKGROUND
Back in the 1970s, the administration of oral antibiotics combined with mechanical bowel preparation prior to colorectal surgery was considered standard procedure and adopted widely. Subsequent evidence suggested that bowel cleansing was unnecessary, even harmful, and hence was abandoned. Most recent evidence, however, suggests that full preparation significantly improves a spectrum of colectomy-specific postoperative outcomes.


OBJECTIVE
The purpose of this review was to describe existing literature regarding the optimal bowel preparation regimen prior to elective colorectal resection. In addition, we evaluate the available evidence on each component-oral antibiotics, mechanical bowel preparation and intravenous antibiotics, with regard to short-term postoperative outcomes.


CONCLUSIONS
Current best evidence suggests that colorectal resection should be preceded by a combination of oral antibiotics, mechanical bowel preparation and intravenous antibiotics at induction. Further randomized controlled trials are required due to a paucity of level 1 evidence.
Division of Colorectal Surgery, New York Presbyterian Hospital, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, Floor 8, New York City, 10032, NY, USA.
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Murray
Division of Colorectal Surgery, New York Presbyterian Hospital, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, Floor 8, New York City, 10032, NY, USA. rpk2118@cumc.columbia.edu.|Mailman School of Public Health, Columbia University, 722 W 168th St, New York City, 10032, NY, USA. rpk2118@cumc.columbia.edu.
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Kiran
D003082:Colectomy / Q000009:adverse effects*; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011300:Preoperative Care
Anastomotic leak; Antibiotics; Colorectal resection; Mechanical bowel preparation; Postoperative outcomes; Quality; Surgical site infection