Mechanical bowel preparation for elective colorectal surgery: a multicentre randomised trial

Area of Science:

• Colorectal Surgery
• Surgical Preparation
• Clinical Trials

Background:

• Mechanical bowel preparation is a standard pre-operative procedure for elective colorectal surgery.
• The necessity and impact of mechanical bowel preparation on surgical outcomes remain debated.
• This study aimed to evaluate anastomotic leakage rates with and without mechanical bowel preparation.

Purpose of the Study:

• To compare the incidence of anastomotic leakage after elective colorectal resections.
• To determine if mechanical bowel preparation influences the risk of anastomotic leakage.
• To assess the safety and efficacy of omitting mechanical bowel preparation.

Main Methods:

• A multicenter randomized non-inferiority trial involving 1431 patients undergoing elective colorectal surgery.
• Patients were assigned to either receive mechanical bowel preparation or no preparation (normal diet).
• The primary endpoint was anastomotic leakage, with a median follow-up of 24 days.

Main Results:

• The rate of anastomotic leakage was similar between groups: 4.8% with mechanical bowel preparation vs. 5.4% without (p=0.69).
• Patients who underwent mechanical bowel preparation had significantly fewer post-leakage abscesses (0.3% vs. 2.5%, p=0.001).
• No significant differences were observed in other septic complications, wound dehiscence, or mortality.

Conclusions:

• Mechanical bowel preparation can be safely omitted before elective colorectal surgery.
• Abandoning mechanical bowel preparation does not increase the risk of anastomotic leakage.
• The findings support a change in current surgical preparation protocols.