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Updated: Jun 26, 2026
Murine Ileocolic Bowel Resection with Primary Anastomosis
Published on: October 29, 2014
Mechanical bowel preparation for elective colorectal surgery
Katia K F G Guenaga1, Delcio Matos, Peer Wille-Jørgensen
1Surgical Gastroenterology Department, Ferderal University of São Paulo, Marivaldo Fernandes, 152 apto. 13, Guarujá, São Paulo, Brazil, 11 440-050. kaci@uol.com.br
Background:
The presence of bowel contents during surgery has been related to anastomotic leakage, but the belief that mechanical bowel preparation (MBP) is an efficient agent against leakage and infectious complications is based on observational data and expert opinions only.
Objectives:
To determine the security and effectiveness of MBP on morbidity and mortality in colorectal surgery.
Search Strategy:
Publications describing trials of MBP before elective colorectal surgery were sought through searches of MEDLINE, EMBASE, LILACS, and The Cochrane Library; by handsearching relevant medical journals and conference proceedings, and through personal communication with colleagues.Searches were performed March 13, 2008.
Selection Criteria:
Randomised controlled trials (RCTs) including participants submitted for elective colorectal surgery. Eligible interventions included any type of MBP compared with no MBP. Primary outcomes included anastomosis leakage - both rectal and colonic - and combined figures. Secondary outcomes included mortality, peritonitis, reoperation, wound infection, extra-abdominal complications, and overall surgical site infections.
Data Collection And Analysis:
Data were independently extracted and checked. The methodological quality of each trial was assessed. Details of randomisation, blinding, type of analysis, and number lost to follow up were recorded. For analysis, the Peto-Odds Ratio (OR) was used as the default (no statistical heterogeneity was observed).
Main Results:
Four new trials were included at this update (total 13 RCTs with 4777 participants; 2390 allocated to MBP (Group A), and 2387 to no preparation (Group B), before elective colorectal surgery) .Anastomotic leakage occurred:(i) in 10.0% (14/139) of Group A, compared with 6.6% (9/136) of Group B for low anterior resection; Peto OR 1.73 (95% confidence interval (CI): 0.73 to 4.10).(ii) in 2.9% (32/1226) of Group A, compared with 2.5% (31/1228) of Group B for colonic surgery; Peto OR 1.13 (95% CI: 0.69 to 1.85). Overall anastomotic leakage occurred in 4.2% (102/2398) of Group A, compared with 3.4% (82/2378) of Group B; Peto OR 1.26 (95% CI: 0.941 to 1.69). Wound infection occurred in 9.6% (232/2417) of Group A, compared with 8.3% (200/2404) of Group B; Peto OR 1.19 (95% CI: 0.98 to 1.45). Sensitivity analyses did not produce any differences in overall results.
Authors' Conclusions:
There is no statistically significant evidence that patients benefit from MBP. The belief that MBP is necessary before elective colorectal surgery should be reconsidered. Further research on patients submitted for elective colorectal surgery in whom bowel continuity is restored, with stratification for colonic and rectal surgery, is still warranted.
Insights
Mechanical bowel preparation (MBP) before elective colorectal surgery does not significantly reduce anastomotic leakage or wound infections. Current practices should be reconsidered due to a lack of evidence supporting MBP
Area of Science:
- Colorectal Surgery
- Surgical Complications
- Evidence-Based Medicine
Background:
- Anastomotic leakage is a risk in colorectal surgery, often linked to bowel content presence.
- Mechanical bowel preparation (MBP) is widely believed to prevent complications, but this is based on limited data.
Purpose of the Study:
- To evaluate the safety and effectiveness of MBP in reducing morbidity and mortality in colorectal surgery patients.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) comparing MBP with no MBP.
- Searched MEDLINE, EMBASE, LILACS, and Cochrane Library up to March 2008.
- Primary outcomes: anastomotic leakage and mortality; Secondary outcomes: infections and reoperations.
Main Results:
- 13 RCTs with 4777 participants were analyzed.
- No significant difference in overall anastomotic leakage (4.2% with MBP vs. 3.4% without).
- No significant difference in wound infection rates (9.6% with MBP vs. 8.3% without).
Conclusions:
- No statistically significant evidence supports the routine use of MBP before elective colorectal surgery.
- The necessity of MBP should be re-evaluated.
- Further research is needed, particularly stratifying for colonic versus rectal surgery.
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