Mechanical Bowel Preparation for Elective Colorectal Surgery: Is it Enough?
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
We recently read with great interest the article of Dr. Peppas and colleagues and strongly favour their approach and concerns about the mechanical bowel preparation of colorectal patients (MBP).1 In order to give our contribution to the discussion, we would like to focus on some issues that still need to be answered about this time-honoured procedure.
To date, 12 randomised controlled trials (RCT) are present in the literature including 4,919 patients (2,463 in the MBP group and 2,456 in the non-MBP group).2–13 The overall analysis of the main outcome measures shows that no parameter reaches the statistical significance between MBP vs. non-MBP patients (Table 1).The only exception is represented by the occurrence of cardiac events (acute myocardial infarctions, atrial fibrillations, heart failures, angina pectoris) that seem decreased in the non-MBP group (Table 1). The reasons for this influence could lie in the well-known effects of MBP on body fluids (dehydration) and ele ...
- Peppas G, Alexiou VG, Falagas ME. Bowel cleansing before bowel surgery: major discordance between evidence and practice. J Gastrointest Surg 2008; [Epub ahead of print].
- Brownson P, Jenkins S, Nott D et al. Mechanical bowel preparation before colorectal surgery: results of a prospective randomized trial [abstract]. Br J Surg 1992;79:461–462.
- Santos JC Jr, Batista J, Sirimarco MT, Guimarães AS, Levy CE. Prospective randomized trial of mechanical bowel preparation in patients undergoing elective colorectal surgery. Br J Surg. 1994;81(11):1673–1676, Medline DOI 10.1002/bjs.1800811139. CrossRef
- Burke P, Mealy K, Gillen P, Joyce W, Traynor O, Hyland J. Requirement for bowel preparation in colorectal surgery. Br J Surg 1994;81(6):907–910, Medline DOI 10.1002/bjs.1800810639. CrossRef
- Miettinen RP, Laitinen ST, Mäkelä JT, Pääkkönen ME. Bowel preparation with oral polyethylene glycol electrolyte solution vs. no preparation in elective open colorectal surgery: prospective, randomized study. Dis Colon Rectum 2000;43(5):669–675, Medline DOI 10.1007/BF02235585. CrossRef
- Zmora O, Mahajna A, Bar-Zakai B, Rosin D, Hershko D, Shabtai M et al. Colon and rectal surgery without mechanical bowel preparation: a randomized prospective trial. Ann Surg 2003;237(3):363–367, Medline DOI 10.1097/00000658-200303000-00010. CrossRef
- Bucher P, Gervaz P, Soravia C, Mermillod B, Erne M, Morel P. Randomized clinical trial of mechanical bowel preparation versus no preparation before elective left-sided colorectal surgery. Br J Surg 2005;92(4):409–414, Medline DOI 10.1002/bjs.4900. CrossRef
- Ram E, Sherman Y, Weil R, Vishne T, Kravarusic D, Dreznik Z. Is mechanical bowel preparation mandatory for elective colon surgery? A prospective randomized study. Arch Surg. 2005;140(3):285–288, Medline DOI 10.1001/archsurg.140.3.285. CrossRef
- Fa-Si-Oen P, Roumen R, Buitenweg J, van de Velde C, van Geldere D, Putter H et al. Mechanical bowel preparation or not? Outcome of a multicenter, randomized trial in elective open colon surgery. Dis Colon Rectum 2005;48(8):1509–1516, Medline DOI 10.1007/s10350-005-0068-y. CrossRef
- Zmora O, Mahajna A, Bar-Zakai B, Hershko D, Shabtai M, Krausz MM et al. Is mechanical bowel preparation mandatory for left-sided colonic anastomosis? Results of a prospective randomized trial. Tech Coloproctol 2006;10(2):131–135, Medline DOI 10.1007/s10151-006-0266-1. CrossRef
- Jung B, Påhlman L, Nyström PO, Nilsson E, Mechanical Bowel Preparation Study Group. Multicentre randomized clinical trial of mechanical bowel preparation in elective colonic resection. Br J Surg 2007;94(6):689–695, Medline DOI 10.1002/bjs.5816. CrossRef
- Pena-Soria MJ, Mayol JM, Anula-Fernandez R, Arbeo-Escolar A, Fernandez-Represa JA. 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 2007;11(5):562–567, Medline DOI 10.1007/s11605-007-0139-6. CrossRef
- Contant CM, Hop WC, van't Sant HP, Oostvogel HJ, Smeets HJ, Stassen LP et al. Mechanical bowel preparation for elective colorectal surgery: a multicentre randomised trial. Lancet 2007;370(9605):2112–2117, Medline DOI 10.1016/S0140-6736(07)61905-9. CrossRef
- Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17(1):1–12, Medline DOI 10.1016/0197-2456(95)00134-4. CrossRef
- Mechanical Bowel Preparation for Elective Colorectal Surgery: Is it Enough?
Journal of Gastrointestinal Surgery
Volume 13, Issue 7 , pp 1392-1394
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links