Mechanical bowel preparation should not be done before elective colorectal surgery

21 Dec 2007
Colorectal surgery can be done safely without mechanical bowel preparation, and the practice is unnecessary and should be abandoned, according to an article in this week’s issue of The Lancet. Mechanical bowel preparation for elective colorectal surgery: a multicentre randomised trial

Mechanical bowel preparation is common practice before elective colorectal surgery and is supposed to prevent anastomotic leakage and septic complications that can cause morbidity and mortality. However, the practice has been shown to have negative side-effects such as bacterial translocation, electrolyte disturbance, and discomfort for patients. Furthermore, recent studies have shown that anastomotic leakage and other infectious complications are more likely to occur in patients who have received mechanical bowel preparation, questioning the need and clinical value of the procedure.

Dr Caroline Contant (Ikazia Hospital, Rotterdam, Netherlands) and colleagues did a multicentre randomised trial of 1431 patients to compare the outcome of elective colorectal resections with and without mechanical bowel preparation. The researchers found that the rate of anastomotic leakage was similar between patients who were given preoperative mechanical bowel preparation and those who were not (4•8% vs 5•4%). However, patients who had mechanical bowel preparation had fewer abscesses after anastomotic leakage than those who did not (0•3% vs 2•5%). Other septic complications, mortality, and length of hospital stay were similar in the two groups.

The authors conclude by calling for an end to the practice of mechanical bowel preparation: “The conclusion that elective colorectal surgery can be safely done without mechanical bowel preparation is justified. In view of the possible disadvantages of this practice, patient discomfort, and the absence of clinical value, we advise that mechanical bowel preparation before elective colorectal surgery should be abandoned.”

In an accompanying Comment, Dr Cameron Platell (St John of God Hospital, West Perth, Australia) and Dr John Hall (University of Western Australia, Perth, Australia) say that some doubts still need to be resolved, especially for patients undergoing low rectal anastomoses. They go on: “Although evidence from trials favours not having mechanical bowel preparation, we should consider each case carefully, otherwise the chance of making an inappropriate decision exists with great consequences for patients.”