ArticlesMechanical bowel preparation for elective colorectal surgery: a multicentre randomised trial
Introduction
Symptomatic anastomotic leakage is the most important surgical complication after colorectal surgery and can cause morbidity and mortality. Mechanical bowel preparation has been regarded as an efficient strategy to prevent anastomotic leakage and septic complications. Observational data and expert opinions1, 2, 3, 4 have traditionally held that mechanical bowel preparation before colorectal surgery reduces faecal mass and bacterial count in the lumen. However, in the past few decades, the practice has been questioned.5, 6, 7, 8, 9, 10 In two studies, anastomotic leakage was more likely to occur in patients who had received mechanical bowel preparation before surgery.7, 8 However, these trials were underpowered, because of insufficient participants. We aimed to compare the outcome of elective colorectal resections with and without mechanical bowel preparation in terms of anastomotic leakage and other complications.
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Study participants
Between April, 1998, and February, 2004, we enrolled patients at 13 participating hospitals (including nine teaching hospitals) in the Netherlands. The main criterion for inclusion was an indication for elective colorectal surgery with primary anastomosis. Patients were excluded if they had an acute laparotomy; had laparoscopic colorectal surgery; had a contraindication for the use of mechanical bowel preparation; had an a priori deviating ileal stoma; or were aged younger than 18 years.
Results
The figure shows the trial profile. Between April, 1998, and February, 2004, we enrolled 1431 patients. 77 patients were excluded from analysis of the primary endpoint: 46 (3·2%) because they did not have a bowel resection; 21 (1·5%) because we did not have outcome data; and 10 (0·7%) because they either withdrew consent, died, had an acute laparotomy, underwent surgery elsewhere, or cancelled their operation. Baseline characteristics are shown in table 1. By chance, more patients who smoked
Discussion
Our study did not show any differences in anastomotic leakage between patients who were given preoperative mechanical bowel preparation before elective colorectal surgery and those who we not. Mortality and length of hospital stay were also similar in the two groups. However, patients who did not have mechanical bowel preparation had a slightly higher rate of intra-abdominal abscesses after anastomotic leakage. We did not regard the very low rate of abscesses to be of major clinical importance;
References (29)
- et al.
A controlled clinical trial of whole gut lavage as a method of bowel preparation for colonic operations
Am J Surg
(1979) - et al.
Effect of mechanical bowel preparation with polyethyleneglycol on bacterial contamination and wound infection in patients undergoing elective open colon surgery
Clin Microbiol Infect
(2005) - et al.
Preoperative preparation of the colon
Surg Gynecol Obstet
(1971) - et al.
The relative significance of preoperative oral antibiotics, mechanical bowel preparation, and peroperative peritoneal contamination in avoidance of sepsis after radical surgery for ulcerative colitis and Crohn's disease of the large bowel
Br J Surg
(1971) Preoperative preparation of the colon and other factors affecting anastomotic healing
Cancer
(1971)- et al.
Mechanical bowel preparation for colonic resection and anastomosis
Br J Surg
(1987) - et al.
Requirement for bowel preparation in colorectal surgery
Br J Surg
(1994) - et al.
Prospective randomized trial of mechanical bowel preparation in patients undergoing elective colorectal surgery
Br J Surg
(1994) - et al.
Mechanical bowel preparation before colorectal surgery: results of a prospective randomized trial
Br J Surg
(1992) - et al.
Bowel preparation with oral polyethylene glycol electrolyte solution versus no preparation in elective open colorectal surgery: prospective, randomized study
Dis Colon Rectum
(2000)
Colon and rectal surgery without mechanical bowel preparation: a randomized prospective trial
Ann Surg
Bowel preparation is associated with spillage of bowel contents in colorectal surgery
Dis Colon Rectum
Spontaneous bacterial peritonitis during bowel preparation: an example of clinical translocation
South Med J
Aggressive bowel preparation does not enhance bacterial translocation, provided the mucosal barrier is not disrupted: a prospective, randomized study
Dis Colon Rectum
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