The Controversies of Mechanical Bowel and Oral Antibiotic Preparation in Elective Colorectal Surgery

The Controversies of Mechanical Bowel and Oral Antibiotic Preparation in Elective Colorectal Surgery

Rollins KE and Lobo, DN The Controversies of Mechanical Bowel and Oral Antibiotic Preparation in Elective Colorectal Surgery. Ann Surg 2020. DOI: 10.1097/SLA.0000000000003985

What is already known:

There has long been controversy and debate in the surgical world over the benefits (or not) of using mechanical bowel prep (MBP) prior to elective colorectal surgery. Whilst the question of MBP use alone compared with no bowel prep has been answered, (there is no benefit), there has been a resurgence of interest in the use of oral antibiotic solution (OAB). The authors of this article have previously published a comprehensive meta-analysis of this subject [reviewed here], but two significant RCTs have been subsequently published and the authors sought to update this, and discuss where it leaves us.

What this paper adds:

The updated analysis compared OAB vs no bowel preparation and MBP + OAB vs no bowel preparation. Overall the two new RCTs did not alter the results; don’t let the headline put you off, this paper is well worth a read. The no-change was partly due to the small numbers in the studies when compared to some of the larger national databases which was used as part of the analysis (one had >30,000 patients). It brings into question the of using smaller RCT data versus “real life” larger cohort studies which the authors discuss in detail. Also the question of using MBP and OAB versus OAB alone is still unanswered. The authors point out the high heterogeneity in some of the outcomes of the meta-analysis suggests the current data are far from conclusive and so still need one big multicentre possibly multinational study to help answer this question one final time. With patients randomised into three distinct groups – no bowel prep, OAB + MPB and OAB alone.

Chris Jones, Guildford. @chrisnjones.