Traditional bowel preparation versus osmotic agent mannitol for preoperative colonic cleansing in elective colorectal...

The need for mechanical cleansing of the bowel before elective colorectal surgery is generally accepted. There are various methods for preparation in use today, but it is still controversial which of them is superior to the others.

To determine whether there is a significant difference in postoperative infectious wound complications rate between the traditional bowel preparation and oral lavage with the osmotic agent Mannitol.

A retrospective study from January 1997 to June 2000 was performed. Patients who underwent elective surgery for colorectal carcinomas were divided into two groups according to the method of colonic cleansing that was used. The traditional bowel preparation was performed with 30.0 cc Castor oil given per os in the day before the operation and three soap enemas (Group I). Patients from the other group (Group II) were given 500 cc 10% Mannitol in the day before the operation.

There were 154 patients in Group I and 36 patients in Group II. Infectious wound complications developed in 26 patients from Group I versus 13 patients from Group II. The difference was statistically significant (16.9% vs. 36.1%, p < 0.01). The differences in the incidence of anastomotic leaks and mortality rate between the two groups were without statistical significance.

The use of Mannitol is associated with increase in the postoperative infectious wound complications and therefore should be avoided as colonic cleansing method in elective colorectal surgery.