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Is mechanical bowel preparation mandatory for elective colon surgery? A prospective randomized study
Edward Ram1, Yevgeni Sherman, Ruben Weil
1Division of General Surgery, Rabin Medical Center, Campus Golda, Petach Tikva Sackler Medical School, Tel Aviv University, Tel Aviv, Israel. eramadan@actcom.net.il
Background:
Bowel preparation prior to colonic surgery usually includes antibiotic therapy together with mechanical bowel preparation (MBP). Mechanical bowel preparation may cause discomfort to the patient, prolonged hospitalization, and water and electrolyte imbalance. It was assumed that with the improvement in surgical technique together with the use of more effective prophylactic antibiotics, it was possible that MBP would no longer be necessary.
Hypothesis:
There is no statistical difference in the postoperative results of patients who undergo elective colon resection with MBP as compared with those who have no MBP.
Design And Patients:
The study includes all patients who had elective large bowel resection at Campus Golda between April 1, 1999, and March 31, 2002. Emergency operations were not included. The patients were randomly assigned to the 2 study groups (with or without MBP) according to identification numbers. All patients were treated with intravenous and oral antibiotics prior to surgery. The patients in the MBP group received Soffodex for bowel preparation.
Results:
A total of 329 patients participated in the study, 165 without MBP and 164 with MBP. The 2 groups were similar in age, sex, and type of surgical procedure. Two hundred sixty-eight patients (81.5%) underwent surgery owing to colorectal cancer and 61 patients (18.5%) owing to benign disease. The hospitalization period was longer in the bowel-prepared group (mean +/- SD, 8.2 +/- 5.1 days) as compared with the nonprepared group (mean +/- SD, 8.0 +/- 2.7 days). However, this difference was not statistically significant. The time until the first bowel movement was similar between the 2 groups: a mean +/- SD of 4.2 +/- 1.3 days in the nonprepared group as compared with a mean +/- SD of 4.3 +/- 1.1 days in the prepared group (P = NS). Four patients (1.2%) died in the postoperative course owing to acute myocardial infarction and pulmonary embolism. Sixty-two patients (37.6%) of the non-MBP group suffered from postoperative complications as compared with 77 patients (46.9%) of the MBP group.
Conclusion:
Our results suggest that no advantage is gained by preoperative MBP in elective colorectal surgery.
Insights
Mechanical bowel preparation (MBP) is not necessary for elective colorectal surgery. Studies show no significant difference in postoperative outcomes or complications between patients who undergo MBP and those who do not.
Area of Science:
- Colorectal surgery
- Surgical preparation
- Gastroenterology
Background:
- Mechanical bowel preparation (MBP) is a standard procedure before colonic surgery, often combined with antibiotics.
- MBP can lead to patient discomfort, extended hospital stays, and fluid/electrolyte imbalances.
- Advancements in surgical techniques and antibiotics raised questions about the continued necessity of MBP.
Purpose of the Study:
- To determine if mechanical bowel preparation (MBP) is essential for elective colon resection.
- To compare postoperative outcomes in patients who received MBP versus those who did not.
Main Methods:
- A randomized study involving 329 patients undergoing elective large bowel resection.
- Patients were assigned to groups with or without MBP, all receiving antibiotics.
- The MBP group used Soffodex for bowel preparation.
Main Results:
- No statistically significant difference in postoperative results between the MBP and non-MBP groups.
- Hospitalization duration and time to first bowel movement were similar in both groups.
- Postoperative complication rates were comparable, with 37.6% in the non-MBP group and 46.9% in the MBP group.
Conclusions:
- Preoperative mechanical bowel preparation (MBP) offers no discernible advantage in elective colorectal surgery.
- The findings suggest that MBP can be omitted without negatively impacting patient outcomes.
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