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Preoperative mechanical bowel preparation versus no preparation for pediatric intestinal surgery: a systematic review
Rajpal Singh Sisodiya1, Prince Raj2, Akanksha Tomar3
1Department of Pediatric Surgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India. rssisodiyanscbpediasurgery@gmail.com.
Insights
Mechanical bowel preparation (MBP) before pediatric intestinal surgery does not reduce infection risk and may prolong recovery. Routine MBP is likely unnecessary, but specific cases may still require it.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Evidence-Based Medicine
Background:
- Mechanical bowel preparation (MBP) is traditionally used in pediatric intestinal surgery, aiming to decrease infection risk.
- Adult studies suggest benefits only when MBP is combined with oral antibiotics, but pediatric evidence is inconsistent.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy of MBP in pediatric elective intestinal surgery.
- To evaluate MBP's impact on surgical site infections (SSI), anastomotic leaks (AL), and intra-abdominal abscesses (IAA).
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials and comparative observational cohorts.
- Searched databases up to August 2025, including 17 studies with 3,036 children.
- Assessed outcomes including SSI, AL, IAA, ileus, bowel obstruction, and length of stay (LOS) using random-effects models and GRADE certainty assessment.
Main Results:
- MBP did not reduce the incidence of SSI, AL, or IAA.
- Moderate certainty for SSI and low certainty for AL/IAA outcomes.
- MBP was associated with a longer length of stay and potential non-significant increases in ileus and bowel obstruction.
Conclusions:
- Current evidence indicates no significant benefit of MBP in pediatric elective intestinal surgery.
- Routine MBP may delay patient recovery and appears unnecessary within Enhanced Recovery After Surgery (ERAS) protocols.
- Further high-quality multicenter trials are needed to definitively assess MBP's role, though it may be indicated for specific functional or reconstructive reasons.
Background:
Mechanical bowel preparation (MBP) has traditionally been routine before pediatric intestinal surgery, based on the belief that it reduces the risk of infection. In adults, benefits are only observed when MBP is combined with oral antibiotics; however, evidence in pediatrics remains limited and inconsistent.
Methods:
We conducted a systematic review and meta-analysis (PROSPERO CRD420251133552) following PRISMA 2020 and Cochrane guidelines, searching databases up to August 2025. Eligible studies included Randomized controlled trials and comparative observational cohorts comparing MBP with no MBP in elective Pediatric intestinal surgery. The primary outcome was surgical site infection (SSI); secondary outcomes included anastomotic leak (AL), intra-abdominal abscess (IAA), ileus, bowel obstruction, and length of stay (LOS). Random-effects models produced pooled estimates, and certainty was assessed using the GRADE approach.
Results:
Seventeen studies involving 3,036 children were included. MBP showed no reduction in SSI, AL, or IAA, with moderate certainty for SSI and low certainty for AL/IAA due to rare events. MBP was associated with longer LOS and possible non-significant increases in ileus and obstruction.
Conclusion:
Current evidence suggests that MBP offers no significant benefits in pediatric elective intestinal surgery and may even delay recovery. Within the framework of ERAS protocols, routine use of MBP appears unnecessary. However, MBP might still be required for specific functional or reconstructive indications. Further high-quality multicentre trials are essential before any definitive conclusions can be drawn regarding its discontinuation.
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