Skip to main content
SpringerLink
Log in

Mechanical bowel preparation for colorectal surgery: a meta-analysis on abdominal and systemic complications on almost 5,000 patients

  • Review
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

Several studies concluded that mechanical bowel preparation (MBP) does not confer any advantage on reducing the anastomotic leak rate or wound infections. The aim of this meta-analysis was to review all prospective randomised controlled trials on the use of MBP before colorectal surgery in order to find differences in the rates of abdominal and systemic complications in view of recent published articles.

Methods

Review of all randomised prospective trials compare MBP vs. non-MBP. Primary outcome measures were anastomotic leakages, abdomino-pelvic abscesses and postoperative ileus. Secondary outcomes were wound infections, extra-abdominal complications (urinary infections, pulmonary infections, deep venous thrombosis or pulmonary embolism, cardiac events), sepsis and mortality.

Results

Twelve articles met the inclusion criteria with 4,919 patients. The non-MBP group showed no significant increase of the anastomotic leakages (3.4% vs. 4.1%; p = NS) and wound infections (8.7% vs. 9.6%; p = NS) but had a lower rate of postoperative cardiac events (2.5% vs. 4.0%; p = 0.04).

Conclusion

The evidence from recent studies, combined with previous ones, further suggests that the dogma of the necessity of mechanical bowel preparation before elective colorectal surgery should be reconsidered.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Brownson P, Jenkins S, Nott D et al (1992) Mechanical bowel preparation before colorectal surgery: results of a prospective randomized trial [abstract]. Br J Surg 79:461–462

    Google Scholar 

  2. Santos JC Jr, Batista J, Sirimarco MT, Guimarães AS, Levy CE (1994) Prospective randomized trial of mechanical bowel preparation in patients undergoing elective colorectal surgery. Br J Surg 81(11):1673–1676

    Article  PubMed  Google Scholar 

  3. Burke P, Mealy K, Gillen P, Joyce W, Traynor O, Hyland J (1994) Requirement for bowel preparation in colorectal surgery. Br J Surg 81(6):907–910

    Article  PubMed  CAS  Google Scholar 

  4. Miettinen RP, Laitinen ST, Mäkelä JT, Pääkkönen 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(5):669–675

    Article  PubMed  CAS  Google Scholar 

  5. Zmora O, Mahajna A, Bar-Zakai B, Rosin D, Hershko D, Shabtai M et al (2003) Colon and rectal surgery without mechanical bowel preparation: a randomized prospective trial. Ann Surg 237(3):363–367

    Article  PubMed  Google Scholar 

  6. 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(4):409–414

    Article  PubMed  CAS  Google Scholar 

  7. 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(3):285–288

    Article  PubMed  Google Scholar 

  8. Fa-Si-Oen P, Roumen R, Buitenweg J, van de Velde C, van Geldere D, Putter H et al (2005) Mechanical bowel preparation or not? Outcome of a multicenter, randomized trial in elective open colon surgery. Dis Colon Rectum 48(8):1509–1516

    Article  PubMed  Google Scholar 

  9. Zmora O, Mahajna A, Bar-Zakai B, Hershko D, Shabtai M, Krausz MM et al (2006) Is mechanical bowel preparation mandatory for left-sided colonic anastomosis? Results of a prospective randomized trial. Tech Coloproctol 10(2):131–135

    Article  PubMed  CAS  Google Scholar 

  10. Jung B, Påhlman L, Nyström PO, Nilsson E (2007) Mechanical bowel preparation study group. Multicentre randomized clinical trial of mechanical bowel preparation in elective colonic resection. Br J Surg 94(6):689–695

    Article  PubMed  CAS  Google Scholar 

  11. Pena-Soria MJ, Mayol JM, Anula-Fernandez R, Arbeo-Escolar A, Fernandez-Represa JA (2007) Mechanical bowel preparation for elective colorectal surgery with primary intraperitoneal anastomosis by a single surgeon: interim analysis of a prospective single-blinded randomized trial. J Gastrointest Surg 11(5):562–567

    Article  PubMed  Google Scholar 

  12. Contant CM, Hop WC, van’t Sant HP, Oostvogel HJ, Smeets HJ, Stassen LP et al (2007) Mechanical bowel preparation for elective colorectal surgery: a multicentre randomised trial. Lancet 370(9605):2112–2117

    Article  PubMed  Google Scholar 

  13. Wille-Jorgensen P, Guenaga KF, Matos D, Castro AA (2005) Pre-operative mechanical bowel cleansing or not? an updated meta-analysis. Colorectal Dis 7(4):304–310

    Article  PubMed  CAS  Google Scholar 

  14. Guenaga KF, Matos D, Castro AA, Atallah AN, Wille-Jorgensen P (2005) Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev 1:CD001544

    PubMed  Google Scholar 

  15. Wille-Jørgensen P, Guenaga KF, Castro AA, Matos D (2003) Clinical value of preoperative mechanical bowel cleansing in elective colorectal surgery: a systematic review. Dis Colon Rectum 46(8):1013–1020

    Article  PubMed  Google Scholar 

  16. 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(9):1125–1130

    Article  PubMed  CAS  Google Scholar 

  17. Bucher P, Mermillod B, Morel P, Soravia C (2004) Does mechanical bowel preparation have a role in preventing postoperative complications in elective colorectal surgery. Swiss Med Wkly 134(5–6):69–74

    PubMed  Google Scholar 

  18. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary. Control Clin Trials 17(1):1–12

    Article  PubMed  CAS  Google Scholar 

  19. Irving AD, Scrimgeour D (1987) Mechanical bowel preparation for colonic resection and anastomosis. Br J Surg 74(7):580–581

    Article  PubMed  CAS  Google Scholar 

  20. Platell C, Hall J (1998) What is the role of mechanical bowel preparation in patients undergoing colorectal surgery. Dis Colon Rectum 41(7):875–882 Jul

    Article  PubMed  CAS  Google Scholar 

  21. Zmora O, Pikarsky AJ, Wexner SD (2001) Bowel preparation for colorectal surgery. Dis Colon Rectum 44(10):1537–1549

    Article  PubMed  CAS  Google Scholar 

  22. Bucher P, Gervaz P, Egger JF, Soravia C, Morel P (2006) Morphologic alterations associated with mechanical bowel preparation before elective colorectal surgery: a randomized trial. Dis Colon Rectum 49(1):109–112

    Article  PubMed  Google Scholar 

  23. Valantas MR, Beck DE, Di Palma JA (2004) Mechanical bowel preparation in the older surgical patient. Curr Surg 61(3):320–324

    Article  PubMed  Google Scholar 

  24. Mahajna A, Krausz M, Rosin D, Shabtai M, Hershko D, Ayalon A et al (2005) Bowel preparation is associated with spillage of bowel contents in colorectal surgery. Dis Colon Rectum 48(8):1626–1631

    Article  PubMed  Google Scholar 

  25. Lieberman D, Ghormley J, Flora K (1996) Effect of oral sodium phosphate colon preparation on serum electrolytes in patients with normal serum creatinine. Gastrointest Endosc 43:467–469

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, Whipps Cross University Hospital, Leytonstone, London, E11 1NR, UK

    Gianpiero Gravante, Stefano Michele Andreani & Pasquale Giordano

  2. Department of Surgery, University of Tor Vergata in Rome, Rome, Italy

    Riccardo Caruso

Authors
  1. Gianpiero Gravante
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Riccardo Caruso
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stefano Michele Andreani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pasquale Giordano
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gianpiero Gravante.

Additional information

The authors have no financial interests or potential conflicts of interests with the present articles nor have received any funding for its conduction. The first author had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gravante, G., Caruso, R., Andreani, S.M. et al. 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 (2008). https://doi.org/10.1007/s00384-008-0592-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-008-0592-z

Keywords

Search

Navigation