Bowel cleansing before bowel surgery: major discordance between evidence and practice

Mechanical bowel cleansing (preparation) before colorectal surgery is commonly practiced, and medical care guidelines consent to this regimen. This has been an incontestable routine for surgeons for more than 100 years. However, during the last years, several randomized control trials and three meta-analyses led to the accumulation of enough evidence to conclude that no significant benefit is derived from this practice and thus, elective colorectal surgery can be safely done without mechanical bowel cleansing. Furthermore, several complications are attributed to mechanical bowel cleansing including anastomotic leakage, wound infections, and septic and non-septic complications that sometimes lead to the need for reoperation. Surgeons around the world may have to seriously reconsider the common practice of preoperative mechanical bowel cleansing. Despite the unquestionable practical value of mechanical bowel cleansing for bowel handling during anastomotic confection, we believe that current literature provides strong evidence that passed the line where this time-honored tradition may be finally called into question.