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The use of mechanical bowel preparation in elective colorectal surgery
1Department of Surgery, Antrim Area Hospital, Antrim BT41 2RL, United Kingdom. amccoubrey@doctors.org.uk
Background:
Mechanical bowel preparation (MBP) prior to elective colorectal surgery has been in use for many years. It is considered important in preventing post-operative infectious complications after colorectal surgery. The evidence to support these claims is lacking within the medical literature and yet this still remains standard practice in many hospitals. A literature search was undertaken to ascertain the evidence available regarding the use of MBP in elective colorectal surgery.
Methods:
The search included the databases PubMed, Medline and Embase using the keywords "mechanical bowel preparation", "bowel cleansing" and "elective colorectal surgery", a search of recent issues of relevant journals including Diseases of the Colon and Rectum and British Journal of Surgery and backward chaining from articles obtained.
Results And Conclusion:
Most authors recommend that colorectal surgery is safe without pre-operative MBP but that there may some situations in which it may be beneficial (e.g. if there is a small tumour or the possible need for intra-operative colonoscopy). The implication for clinical practice in this situation is that there is not enough strength of evidence at present to recommend a change in practice. There is a need for further higher powered trials to try to answer this question definitively.
Insights
Mechanical bowel preparation before colorectal surgery is common practice but lacks strong evidence. Most authors find surgery safe without it, though some situations may benefit.
Area of Science:
- Colorectal Surgery
- Surgical Preparation
- Evidence-Based Medicine
Background:
- Mechanical bowel preparation (MBP) is a long-standing practice before elective colorectal surgery.
- It is widely believed to prevent post-operative infectious complications.
- However, robust medical evidence supporting its routine use is limited.
Purpose of the Study:
- To review the existing medical literature for evidence supporting the use of MBP in elective colorectal surgery.
Main Methods:
- A comprehensive literature search was conducted using PubMed, Medline, and Embase.
- Keywords included "mechanical bowel preparation," "bowel cleansing," and "elective colorectal surgery."
- Relevant journal issues and backward chaining were also employed.
Main Results:
- The literature suggests that colorectal surgery is generally safe without pre-operative MBP.
- Certain specific scenarios, such as small tumors or potential intra-operative colonoscopy, might benefit from MBP.
- Current evidence is insufficient to mandate a change in standard clinical practice.
Conclusions:
- While elective colorectal surgery can be safe without MBP, its utility in specific cases warrants consideration.
- There is a need for more high-powered clinical trials to definitively establish the role of MBP.
- Current practice should be re-evaluated in light of the limited supporting evidence.
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