Related Experiment Video
Updated: Jun 17, 2026
E-Patient Counseling Trial (E-PACO): Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy
Published on: August 1, 2019
The influence of mechanical bowel preparation in elective lower colorectal surgery
Hans Pieter Van't Sant1, Wibo F Weidema, Wim C J Hop
1Department of Surgery, Ikazia Hospital, Rotterdam, The Netherlands. hpieter44@hotmail.com
Objective:
This study evaluates the effects of mechanical bowel preparation (MBP) on anastomosis below the peritoneal verge and questions the influence of MBP on anastomotic leakage in combination with a diverting ileostomy in lower colorectal surgery.
Summary Background Data:
In a previous large multicenter randomized controlled trial MBP has shown to have no influence on the incidence of anastomotic leakage in overall colorectal surgery. The role of MBP in lower colorectal surgery with or without a diverting ileostomy remains unclear.
Methods:
This study is a subgroup analysis of a prior multicenter (13 hospitals) randomized trial comparing clinical outcome of MBP versus no MBP. Primary end point was the occurrence of anastomotic leakage and secondary endpoints were septic complications and mortality.
Results:
Total of 449 Patients underwent a low anterior resection with a primary anastomosis below the peritoneal verge. The incidence of anastomotic leakage was 7.6% for patients who received MBP and 6.6% for patients who did not. Significant risk factors for anastomotic leakage were the American Society of Anesthesiologists-classification (P = 0.005) and male gender (P = 0.007). Of total, 48 patients received a diverting ileostomy during initial surgery; 27 patients received MBP and 21 patients did not. There were no significant differences regarding septic complications and mortality between both groups.
Conclusion:
MBP has no influence on the incidence of anastomotic leakage in low colorectal surgery. Furthermore, omitting MBP in combination with a diverting ileostomy has no influence on the incidence of anastomotic leakage, septic complications, and mortality rate.
Insights
Mechanical bowel preparation (MBP) does not impact anastomotic leakage rates in lower colorectal surgery. Omitting MBP with a diverting ileostomy also shows no effect on leakage, complications, or mortality.
Area of Science:
- Colorectal Surgery
- Surgical Outcomes
- Gastroenterology
Background:
- Previous studies suggest mechanical bowel preparation (MBP) does not influence anastomotic leakage in general colorectal surgery.
- The specific impact of MBP on low colorectal anastomoses, particularly with diverting ileostomies, remains uncertain.
Purpose of the Study:
- To evaluate the effect of mechanical bowel preparation (MBP) on anastomotic leakage below the peritoneal verge in low colorectal surgery.
- To determine if MBP influences anastomotic leakage when a diverting ileostomy is present.
Main Methods:
- Subgroup analysis of a multicenter randomized trial comparing MBP versus no MBP.
- Assessed primary endpoint of anastomotic leakage and secondary endpoints of septic complications and mortality in 449 patients undergoing low anterior resection.
Main Results:
- Anastomotic leakage occurred in 7.6% of patients with MBP and 6.6% without MBP.
- Significant risk factors for leakage included ASA classification and male gender.
- In patients with a diverting ileostomy, no significant differences in leakage, septic complications, or mortality were observed between MBP and no MBP groups.
Conclusions:
- Mechanical bowel preparation (MBP) does not affect the incidence of anastomotic leakage in low colorectal surgery.
- Omitting MBP in conjunction with a diverting ileostomy does not increase the risk of anastomotic leakage, septic complications, or mortality.
Related Concept Videos
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
01:23Lower GI Series: Barium Enema
Procedure Details
The examination begins by inserting a lubricated rectal tube into the patient's rectum to administer a radiopaque barium solution. The barium flow is carefully...
01:25Endoscopic Procedures II: Colonoscopy
01:26Imaging Studies III: Gastrointestinal Motility Studies and Virtual Colonoscopy
Radionuclide Testing
Radionuclide testing is a sophisticated medical technique for assessing gastrointestinal motility. It focuses on gastric emptying and colonic transit time. Radioactive markers track the movement of food through the digestive system, providing insights into gastrointestinal disorders.
In gastric emptying studies, a meal's liquid and solid...