Preparing the Bowel for Surgery in the Era of Microbiome Sciences

The concept that a "one-size-fits-all" approach can be universally applied to all patients undergoing colorectal surgery is waning in enthusiasm especially given the variation in risk perception among patients and surgeons. In this review, we discuss the scientific rationale in generating a microbiome readout that will inform how to selectively eliminate problematic pathogens while preserving those beneficial bacterial strains that may enhance recovery from surgery. We also provide the reader with practical decision points with which to contemplate the need for a bowel preparation with your patient.