Impact of mechanical bowel preparation in elective colorectal surgery: a meta-analysis

Impact of mechanical bowel preparation in elective colorectal surgery: a meta-analysis

Katie E Rollins, Hannah Javanmard-Emamghissi, Dileep N Lobo.Impact of mechanical bowel preparation in elective colorectal surgery: a meta-analysis. World J Gastroenterol 2018 January 28; 24(4): 519-536

What is already known:

Mechanical bowel preparation (MBP) has long been part of surgical dogma; the rationale behind its use is that it reduces faecal bulk and, therefore bacterial colonisation, thereby reducing the risk of postoperativecomplications such as anastomotic leakage and wound infection, but slowly its routine use has been questioned. It has numerous physiological adverse effects secondary to the dehydration caused, it is distressing for the patient and is associated with prolonging ileus after surgery. There is also concern that it liquefies faeces and so may increase risk of spillage and therefore infection postoperatively. It remains somewhat controversial with advocates on both sides. In fact, it was even the subject of a Pro / Con debate at last year’s ERAS congress in Lyon.

What this paper adds:

This is an excellent and comprehensive meta-analysis by Professor Lobo’s group in Nottingham [NB Prof Lobo is the ERAS Society Scientific Chair]. It follows nicely on from the Cochrane review [2011], but with a further 5 RCT’s and includes over 21,500 patients versus almost 6000 in the Cochrane review. It demonstrates that at present there is no evidence that bowel preparation makes a difference to clinical outcomes in either colonic or rectal surgery, in terms of anastomotic leak rates, surgical site infection, intra-abdominal collection, mortality, reoperation or hospital length of stay. Given its potential adverse effects and patient dissatisfaction rates, it should not be administered routinely to patients undergoing elective colorectal surgery.

Chris Jones, Guildford.