The Role of Oral Antibiotic Preparation in Elective Colorectal Surgery: A Meta-analysis.

The Role of Oral Antibiotic Preparation in Elective Colorectal Surgery: A Meta-analysis.

Rollins KE, Javanmard-Emamghissi H, Acheson AG, Lobo DN. Ann Surg. 2019 Jul;270(1):43-58. doi: 10.1097/SLA.0000000000003145.

What is already known:
The use of mechanical bowel preparation (MBP) has always been an area of controversy, in fact was the subject of a fascinating pro-con debate at the ERAS Congress in Lyon. Current evidence would suggest that it does not impact on morbidity or mortality, so its routine use is not indicated. However the use of oral antibiotics (OAB) before surgery to reduce surgical site infections (SSI) has reignited that debate, or at least muddied the water.

What this paper adds:
This is a meta-analysis of a large number of patients undergoing elective bowel surgery. They received OAB with or without MBP. OAB + MBP showed a significant reduction in SSI, anastomotic leak, 30-day mortality, overall morbidity and development of ileus. OAB vs OAB + MBP showed no difference in SSI or anastomotic leak but did show a reduction in 30-day mortality and ileus with the combination. It would seem that OABs have a role in reducing a number of different postoperative complications, but we need more high quality evidence to say whether the OABs showed be combined with MBP or not.

Chris Jones, Guildford. @chrisnjones