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Mechanical bowel preparations not supported in elective colo-rectal surgeries with anastomosis: A retrospective study

Greta Leitz-Najarian1, Melissa Najarian2

  • 1University of North Carolina, Chapel Hill, NC, USA.

The American Surgeon
|September 30, 2023
PubMed
Abstract

Insights

Routine mechanical bowel preparations (MBPs) in elective colorectal surgery do not significantly reduce wound infection or anastomotic leak rates. Their use may increase urinary tract infections (UTIs) and is not supported by this study.

Area of Science:

  • Colorectal Surgery
  • Surgical Outcomes
  • Patient Safety

Background:

  • Mechanical bowel preparations (MBPs) have been a standard practice in colorectal surgery since the 1970s.
  • Recent evidence questions the efficacy and safety of MBPs, prompting re-evaluation of their role.
  • Complication rates in patients with and without bowel preparations require further investigation.

Purpose of the Study:

  • To analyze the risks and benefits associated with various bowel preparation methods in elective colorectal surgery.
  • To compare complication rates between patients undergoing elective colorectal surgery with different bowel preparation protocols.
  • To determine if mechanical bowel preparation remains the standard of care.

Main Methods:

  • A retrospective case-review of 1237 elective colorectal surgeries conducted between 2008 and 2021.
  • Patients were categorized based on bowel preparation: mechanical bowel preparation (MBP), mechanical bowel preparation with oral antibiotics (OAMBP), oral antibiotics alone (OA), or no bowel preparation.
  • Outcomes including wound infection, anastomotic leak, and urinary tract infections were analyzed, controlling for comorbidities and enema use.

Main Results:

  • Combined MBP and OAMBP groups (436 patients) showed no significant difference in wound infection or anastomotic leak compared to no preparation (636 patients) or OA (165 patients).
  • Urinary tract infections (UTIs) were significantly more frequent in patients who received any bowel preparation (P = .047).
  • No significant differences were observed in other outcomes such as 30-day complications, readmissions, sepsis, pneumonia, or length of stay.

Conclusions:

  • Current data does not support the routine use of mechanical bowel preparations in elective colorectal surgery.
  • The standard of care for bowel preparation in colorectal surgery warrants re-evaluation.
  • Alternative strategies or no bowel preparation may be considered to optimize patient outcomes and reduce complications like UTIs.
Keywords:
bowel preparationcolorectalmechanical bowel preparationrural surgery

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