Advanced Protocols for Preoperative Colon Preparation: Enhancing Outcomes in Colorectal Surgery

<b>Introduction:</b> Since the very beginnings of colorectal surgery, it has been dominated by the effort to reduce postoperative infectious complications and to find a way to prevent the risks associated with the dehiscence of intestinal anastomoses. Despite the technical, technological, and scientific advances achieved in medicine over the last decades, the mortality and morbidity figures in elective gastrointestinal surgery remain at a low, but relatively constant level. They continue to represent a problem that leads to an extension of treatment time, postoperative recovery, length of inpatient treatment, and thus increased expenses for the health system. One of the methods that was supposed to lead to a reduction in infectious complications was the introduction of mechanical cleaning of the large intestine before planned surgery 120 years ago. Successes in the treatment of infections with the help of discovered antibiotics were combined with their prophylactic administration, together with mechanical bowel preparation (MBP).<b>Aim:</b> The main aim was to find pros and cons of MBP in connection with postoperative complications.<b>Materials and methods:</b> In our prospective, international study, we compared a group of patients from 2 clinical sites. In Slovakia this was the 3^rd Surgical Clinic, UNsP Merciful Brothers in Bratislava, and Klinikum Passau in Germany. A total of 418 patients with a benign or malignant colon disease who underwent elective resection were included in the study. Each center had its own preoperative colon preparation scheme. Patients were operated on by knowledgeable surgeons with at least 25 years of experience, either laparoscopically or conventionally. The monitored parameters were the type of operation, the execution of anastomoses, the conversion rate of laparoscopy to laparotomy, mortality, and morbidity. Postoperative complications were grouped into the following types: wound complications, intra-abdominal infections and anastomotic dehiscence, or the need for reoperation.<b>Conclusions:</b> We compared the obtained results with data from current world literature. With its conclusion, our study supported the currently prevailing opinion on mechanical cleansing of the large intestine, namely that it does not bring the desired effect on reducing perioperative infectious complications and dehiscence of anastomoses.