Abstract
Purpose
Mechanical bowel preparation (MBP) for elective colorectal surgery has been practiced as a clinical routine for many decades. However, earlier randomized clinical trials (RCTs) and meta-analyses suggest that MBP should be abandoned before colorectal surgery because of the futility in reducing postoperative complications and motility. The new published results from three RCTs comparing MBP with no MBP in colorectal surgery in 2010 make the updating of systemic review and meta-analysis necessary. The aim of this study was to estimate efficacy of MBP in prevention of postoperative complications for elective colorectal surgery.
Method
A literature search was performed mainly in electronic database including Cochrane Library, EMBASE, and MEDLINE. The inclusion criteria were randomized clinical trials comparing MBP with no MBP before colorectal surgery. Septic complications, reoperation, and death were recorded as primary and secondary outcomes. The meta-analysis was conducted according to the QUOROM statement.
Results
Fourteen RCTs were included in our analysis with a total number of 5,373 patients: 2,682 with MBP and 2,691 without. Comparing with no MBP for elective colorectal surgery, our study showed that MBP had not reduce any postoperative complications when concerning anastomotic leak [odds ratio (OR) 95% confidence interval (CI), 1.08 (0.82–1.43); P = 0.56]; overall SSI [OR 95% CI, 1.26 (0.94–1.68); P = 0.12]; extra-abdominal septic complications [OR 95% CI, 0.98 (0.81–1.18); P = 0.81]; wound infections [OR 95% CI, 1.21 (1.00–1.46); P = 0.05]; reoperation or second intervention rate [OR 95% CI, 1.11 (0.86–1.45); P = 0.42]; and death [OR 95% CI, 0.97(0.63–1.48); P = 0.88].
Conclusion
No evidence was noted supporting the use of MBP in patients undergoing elective colorectal surgery. MBP should be omitted in routine clinical practice.
Similar content being viewed by others
References
Eskicioglu C, Forbes SS, Fenech DS, McLeod RS (2010) Preoperative bowel preparation for patients undergoing elective colorectal surgery: a clinical practice guideline endorsed by the Canadian Society of Colon and Rectal Surgeons. Can J Surg 53:385–395
Hughes ES (1972) Asepsis in large-bowel surgery. Ann R Coll Surg Engl 51:347–356
Nicholson GA, Finlay IG, Diament RH, Molloy RG, Horgan PG, Morrison DS (2011) Mechanical bowel preparation does not influence outcomes following colonic cancer resection. Br J Surg 98:866–871
Scabini S, Rimini E, Romairone E, Scordamaglia R, Damiani G, Pertile D, Ferrando V (2010) Colon and rectal surgery for cancer without mechanical bowel preparation: one-center randomized prospective trial. World J Surg Oncol 8:35
Contant CM, Hop WC, Van'T SH et al (2007) Mechanical bowel preparation for elective colorectal surgery: a multicentre randomised trial. Lancet 370:2112–2117
Jung B, Pahlman L, Nystrom PO, Nilsson E (2007) Multicentre randomized clinical trial of mechanical bowel preparation in elective colonic resection. Br J Surg 94:689–695
Zhu QD, Zhang QY, Zeng QQ, Yu ZP, Tao CL, Yang WJ (2010) Efficacy of mechanical bowel preparation with polyethylene glycol in prevention of postoperative complications in elective colorectal surgery: a meta-analysis. Int J Colorectal Dis 25:267–275
Slim K, Vicaut E, Launay-Savary MV, Contant C, Chipponi J (2009) Updated systematic review and meta-analysis of randomized clinical trials on the role of mechanical bowel preparation before colorectal surgery. Ann Surg 249:203–209
Gravante G, Caruso R, Andreani SM, Giordano P (2008) Mechanical bowel preparation for colorectal surgery: a meta-analysis on abdominal and systemic complications on almost 5,000 patients. Int J Colorectal Dis 23:1145–1150
Wille-Jorgensen P, Guenaga KF, Matos D, Castro AA (2005) Pre-operative mechanical bowel cleansing or not? An updated meta-analysis. Colorectal Dis 7:304–310
Bucher P, Mermillod B, Gervaz P, Morel P (2004) Mechanical bowel preparation for elective colorectal surgery: a meta-analysis. Arch Surg 139:1359–1364
Slim K, Vicaut E, Panis Y, Chipponi J (2004) Meta-analysis of randomized clinical trials of colorectal surgery with or without mechanical bowel preparation. Br J Surg 91:1125–1130
Pineda CE, Shelton AA, Hernandez-Boussard T, Morton JM, Welton ML (2008) Mechanical bowel preparation in intestinal surgery: a meta-analysis and review of the literature. J Gastrointest Surg 12:2037–2044
Muller-Stich BP, Choudhry A, Vetter G, Antolovic D, Mehrabi A, Koninger J, Weitz J, Buchler MW, Gutt CN (2006) Preoperative bowel preparation: surgical standard or past? Dig Surg 23:375–380
Guenaga KK, Matos D, Wille-Jorgensen P (2009) Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev: CD1544
Platell C, Hall J (1998) What is the role of mechanical bowel preparation in patients undergoing colorectal surgery? Dis Colon Rectum 41(875–882):882–883
Bretagnol F, Panis Y, Rullier E, Rouanet P, Berdah S, Dousset B, Portier G, Benoist S, Chipponi J, Vicaut E (2010) Rectal cancer surgery with or without bowel preparation: The French GRECCAR III multicenter single-blinded randomized trial. Ann Surg 252:863–868
Van'T SH, Weidema WF, Hop WC, Oostvogel HJ, Contant CM (2010) The influence of mechanical bowel preparation in elective lower colorectal surgery. Ann Surg 251:59–63
Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF, QUOROM Group (2000) Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Br J Surg 87:1448–1454
Moher D, Pham B, Jones A, Cook DJ, Jadad AR, Moher M, Tugwell P, Klassen TP (1998) Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses? Lancet 352:609–613
Pena-Soria MJ, Mayol JM, Anula R, Arbeo-Escolar A, Fernandez-Represa JA (2008) Single-blinded randomized trial of mechanical bowel preparation for colon surgery with primary intraperitoneal anastomosis. J Gastrointest Surg 12:2103–2108, discussion 2108–2109
Zmora O, Mahajna A, Bar-Zakai B, Hershko D, Shabtai M, Krausz MM, Ayalon A (2006) Is mechanical bowel preparation mandatory for left-sided colonic anastomosis? Results of a prospective randomized trial. Tech Coloproctol 10:131–135
Ram E, Sherman Y, Weil R, Vishne T, Kravarusic D, Dreznik Z (2005) Is mechanical bowel preparation mandatory for elective colon surgery? A prospective randomized study. Arch Surg 140:285–288
Fa-Si-Oen P, Roumen R, Buitenweg J et al (2005) Mechanical bowel preparation or not? Outcome of a multicenter, randomized trial in elective open colon surgery. Dis Colon Rectum 48:1509–1516
Bucher P, Gervaz P, Soravia C, Mermillod B, Erne M, Morel P (2005) Randomized clinical trial of mechanical bowel preparation versus no preparation before elective left-sided colorectal surgery. Br J Surg 92:409–414
Zmora O, Mahajna A, Bar-Zakai B, Rosin D, Hershko D, Shabtai M, Krausz MM, Ayalon A (2003) Colon and rectal surgery without mechanical bowel preparation: a randomized prospective trial. Ann Surg 237:363–367
Miettinen RP, Laitinen ST, Makela JT, Paakkonen ME (2000) Bowel preparation with oral polyethylene glycol electrolyte solution vs. no preparation in elective open colorectal surgery: prospective, randomized study. Dis Colon Rectum 43:669–675
Santos JJ, Batista J, Sirimarco MT, Guimaraes AS, Levy CE (1994) Prospective randomized trial of mechanical bowel preparation in patients undergoing elective colorectal surgery. Br J Surg 81:1673–1676
Burke P, Mealy K, Gillen P, Joyce W, Traynor O, Hyland J (1994) Requirement for bowel preparation in colorectal surgery. Br J Surg 81:907–910
Brownson P, Jenkins SA, Nott D, Ellenbogen S (1992) Mechanical bowel preparation before colorectal surgery: results of a prospective randomized trial. Br J Surg 79:461–462 [abstract]
Jung B, Matthiessen P, Smedh K, Nilsson E, Ransjo U, Pahlman L (2010) Mechanical bowel preparation does not affect the intramucosal bacterial colony count. Int J Colorectal Dis 25:439–442
Young TF, Celis ZJ, Berrospi EF, Payet ME, Ruiz FE (2002) Mechanical preparation in elective colorectal surgery, a usual practice or a necessity? Rev Gastroenterol Peru 22:152–158
Kale TI, Kuzu MA, Tekeli A, Tanik A, Aksoy M, Cete M (1998) Aggressive bowel preparation does not enhance bacterial translocation, provided the mucosal barrier is not disrupted: a prospective, randomized study. Dis Colon Rectum 41:636–641
Drummond RJ, McKenna RM, Wright DM (2011) Current practice in bowel preparation for colorectal surgery: a survey of the members of the Association of Coloproctology of GB & Ireland. Colorectal Dis 13:708–710
Hasenberg T, Langle F, Reibenwein B, Schindler K, Post S, Spies C, Schwenk W, Shang E (2010) Current perioperative practice in rectal surgery in Austria and Germany. Int J Colorectal Dis 25:855–863
Oliveira L, Wexner SD, Daniel N, DeMarta D, Weiss EG, Nogueras JJ, Bernstein M (1997) Mechanical bowel preparation for elective colorectal surgery. A prospective, randomized, surgeon-blinded trial comparing sodium phosphate and polyethylene glycol-based oral lavage solutions. Dis Colon Rectum 40:585–591
Mahajna A, Krausz M, Rosin D, Shabtai M, Hershko D, Ayalon A, Zmora O (2005) Bowel preparation is associated with spillage of bowel contents in colorectal surgery. Dis Colon Rectum 48:1626–1631
Bretagnol F, Alves A, Ricci A, Valleur P, Panis Y (2007) Rectal cancer surgery without mechanical bowel preparation. Br J Surg 94:1266–1271
Vlot EA, Zeebregts CJ, Gerritsen JJ, Mulder HJ, Mastboom WJ, Klaase JM (2005) Anterior resection of rectal cancer without bowel preparation and diverting stoma. Surg Today 35:629–633
Zmora O, Lebedyev A, Hoffman A, Khaikin M, Munz Y, Shabtai M, Ayalon A, Rosin D (2006) Laparoscopic colectomy without mechanical bowel preparation. Int J Colorectal Dis 21:683–687
Jung B, Lannerstad O, Pahlman L, Arodell M, Unosson M, Nilsson E (2007) Preoperative mechanical preparation of the colon: the patient's experience. BMC Surg 7:5
Frizelle FA, Colls BM (2005) Hyponatremia and seizures after bowel preparation: report of three cases. Dis Colon Rectum 48:393–396
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cao, F., Li, J. & Li, F. Mechanical bowel preparation for elective colorectal surgery: updated systematic review and meta-analysis. Int J Colorectal Dis 27, 803–810 (2012). https://doi.org/10.1007/s00384-011-1361-y
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-011-1361-y