Mechanical bowel preparation for elective colorectal surgery should be abandoned

黄建宏

Mechanical bowel preparation for elective colorectal surgery should be abandoned

One of the ERAS elements is avoidance of preoperative bowel preparation (MBP). What kind of evidence can support this recommendation? The study by Katia KFG Guenaga, Delcio Matos, Peer Wille-Jørgensen (1) proved that prophylactic mechanical bowel preparation prior to colorectal surgery has not been proven to be valuable for patients.

The aim of this study (1) is to determine whether mechanical bowel preparation before elective colorectal surgery is really essential for patients.

Of the 4776 participants in the 14 included randomized controlled trials (RCTs), 2398 were allocated for mechanical bowel preparation (Group A), and 2378 for no preparation (Group B), before elective colorectal surgery.

Analysis of these 14 trials showed no statistically significant differences in how well the two groups of patients (mechanical bowel preparation group and the no preparation group) did after surgery in terms of leakage at the surgical join of the bowel, mortality rates, peritonitis, need for reoperation, wound infection, and other non-abdominal complications. Consequently, there is no evidence that mechanical bowel preparation improves the outcome for patients.

Conclusions: Prophylactic mechanical bowel preparation prior to colorectal surgery has not been proven to be valuable for patients. This review suggested MBP should be abandoned.

Reference:

1.      Katia KFG Guenaga, Delcio Matos, Peer Wille-Jørgensen: Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev 2003;(2). CD001544.