Best practices in bowel preparation for colorectal surgery: a 2020 overview

Area of Science:

• Surgical quality improvement
• Gastrointestinal surgery
• Infectious disease prevention

Background:

• Preoperative bowel preparation is evolving, with oral antibiotics (OAB) added to mechanical bowel preparation (MBP) becoming a standard in American guidelines.
• This combined approach (MBP+OAB) remains controversial in clinical practice.

Purpose of the Study:

• To review current literature on bowel preparation strategies.
• To evaluate the efficacy of mechanical bowel preparation (MBP) with and without oral antibiotics (OAB) for surgical outcomes.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) and meta-analyses published since 2009.
• Inclusion of data from American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) studies and international guidelines.

Main Results:

• ACS NSQIP studies did not strongly support MBP+OAB.
• RCTs and meta-analyses suggest OAB alone is superior to no preparation and comparable to MBP+OAB for surgical site infection (SSI) reduction.
• MBP+OAB showed no significant SSI benefit over MBP alone.

Conclusions:

• Current evidence does not consistently support the routine use of MBP+OAB.
• OAB alone appears to be a promising alternative for preoperative bowel preparation.
• Future research, including large RCTs and microbiota analysis, is needed to refine personalized bowel preparation protocols.