Elective colorectal surgery without bowel preparation: a historical control and case-matched study

Area of Science:

• Colorectal Surgery
• Surgical Preparation
• Anastomotic Integrity

Background:

• Traditional colorectal surgery mandates full bowel preparation, including mechanical washout and non-absorbable antibiotics.
• Recent evidence questions the necessity and benefits of this long-standing practice.
• This study investigates the safety of omitting pre-operative mechanical bowel preparation for elective colorectal resections.

Purpose of the Study:

• To evaluate the safety and efficacy of performing ileocolic, colocolic, and colorectal anastomosis without pre-operative mechanical bowel preparation.
• To compare outcomes between patients who received no bowel preparation and those who underwent standard preparation.

Main Methods:

• A prospective study of 59 consecutive patients undergoing elective colorectal surgery without bowel preparation (Non-Prepared Group - NPG).
• Comparison with a historical control group (CG) of 127 patients and a matched control group (MCG) of 59 patients who received standard bowel preparation.
• Primary endpoints: anastomotic leakage and abdominal infections. Secondary endpoints: diet resumption time and hospital stay.

Main Results:

• No significant differences in anastomotic leakage rates between the NPG and CG/MCG (3.5% vs. 4.7% and 6.8%).
• No significant differences in infectious abdominal complications were observed across the groups.
• Significantly faster oral diet resumption (1.4 days vs. 3.4/3.1 days) and shorter hospital stays (5 days vs. 8 days) in the NPG.

Conclusions:

• Mechanical bowel preparation is not essential for safe elective colorectal resections.
• Omitting bowel preparation does not compromise anastomotic integrity or increase infection rates.
• Discontinuing routine mechanical bowel preparation may enhance patient recovery and reduce hospital resource utilization.