International Journal of Colorectal Disease

, Volume 21, Issue 7, pp 683–687 | Cite as

Laparoscopic colectomy without mechanical bowel preparation

  • Oded Zmora
  • Alexander Lebedyev
  • Aviad Hoffman
  • Marat Khaikin
  • Yaron Munz
  • Moshe Shabtai
  • Amram Ayalon
  • Danny Rosin
Original Article



Mechanical bowel preparation prior to colorectal surgery may reduce infectious complications, facilitate tumor localization, and allow intraoperative colonoscopy, if required. However, recent data suggest that mechanical bowel preparation may not facilitate a reduction in infectious complications. During laparoscopic colectomy, manual palpation is blunt, thereby potentially compromising tumor localization. The aim of this study was to assess the utility of mechanical bowel preparation in laparoscopic colectomy.

Materials and methods

A retrospective medical record review of all patients who underwent laparoscopic colectomy was performed. Patients were divided into two groups: those who had preoperative mechanical bowel preparation (Group A) or those who did not (Group B). All relevant perioperative data were reviewed and compared.


Two hundred patients underwent laparoscopic colectomy; 68 (34%) were in Group A and 132 (66%) were in Group B. Sixteen (8%) patients required intraoperative colonoscopy for localization and were evenly distributed between the two groups. The incidence of conversion to laparotomy was slightly higher in Group B (14 vs 9%) due to difficult localization in some cases; however, this difference did not reach statistical significance. Furthermore, there was no significant difference in the postoperative complication rate between the two groups. Specifically, an anastomotic leak and a wound infection were recorded in 4 and 12% of patients in Group A compared to 3 and 17% in Group B, respectively.


Laparoscopic colectomy may be safely performed without preoperative mechanical bowel preparation, although difficult localization may lead to a slightly higher conversion rate. Appropriate patient selection for laparoscopic colectomy without mechanical bowel preparation is essential. Furthermore, bowel preparation should be considered in cases of small and nonpalpable lesions.


Colon surgery Polyethylene glycol Preoperative care Laparoscopic surgery Intraoperative endoscopy 


  1. 1.
    Zmora O, Pikarsky AJ, Wexner SD (2001) Bowel preparation for colorectal surgery. Dis Colon Rectum 44:1537–1549PubMedCrossRefGoogle Scholar
  2. 2.
    Burke P, Mealy K, Gillen P, Joyce W, Traynor O, Hyland J (1994) Requirement for bowel preparation in colorectal surgery. Br J Surg 81:907–910PubMedCrossRefGoogle Scholar
  3. 3.
    Santos JC Jr, 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 81:1673–1676PubMedCrossRefGoogle Scholar
  4. 4.
    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 43:669–675PubMedCrossRefGoogle Scholar
  5. 5.
    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 237:363–367CrossRefPubMedGoogle Scholar
  6. 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 92:409–414CrossRefPubMedGoogle Scholar
  7. 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 140:285–288CrossRefPubMedGoogle Scholar
  8. 8.
    Kim SH, Milsom JW, Church JM, Ludwig KA, Garcia-Ruiz A, Okuda J, Fazio VW (1997) Perioperative tumor localization for laparoscopic colorectal surgery. Surg Endosc 11:1013–1016CrossRefPubMedGoogle Scholar
  9. 9.
    Zmora O, Dinnewitzer AJ, Pikarsky AJ, Efron JE, Weiss EG, Nogueras JJ, Wexner SD (2002). Intraoperative endoscopy in laparoscopic colectomy. Surg Endosc 16:808–811CrossRefPubMedGoogle Scholar
  10. 10.
    Platell C, Hall J (1998) What is the role of mechanical bowel preparation in patients undergoing colorectal surgery? Dis Colon Rectum 41:875–882PubMedCrossRefGoogle Scholar
  11. 11.
    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):1125–1130CrossRefPubMedGoogle Scholar
  12. 12.
    Bucher P, Mermillod B, Gervaz P, Morel P (2004) Mechanical bowel preparation for elective colorectal surgery: a meta-analysis. Arch Surg 139(12):1359–1364CrossRefPubMedGoogle Scholar
  13. 13.
    Guenaga K, Matos D, Castro A, Atallah A, Wille-Jorgensen P (2005) Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev 1:CD001544PubMedGoogle Scholar
  14. 14.
    Rickard MJ, Bokey EL (2001) Laparoscopy for colon cancer. Surg Oncol Clin N Am 10:579–597PubMedGoogle Scholar
  15. 15.
    Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229CrossRefPubMedGoogle Scholar
  16. 16.
    Curet MJ, Putrakul K, Pitcher DE, Josloff RK, Zucker KA (2000) Laparoscopically assisted colon resection for colon carcinoma: perioperative results and long-term outcome. Surg Endosc 14:1062–1066CrossRefPubMedGoogle Scholar
  17. 17.
    Botoman VA, Pietro M, Thirlby RC (1994) Localization of colonic lesions with endoscopic tattoo. Dis Colon Rectum 37:775–776CrossRefPubMedGoogle Scholar
  18. 18.
    Montorsi M, Opocher E, Santambrogio R, Bianchi P, Faranda C, Arcidiacono P, Passoni GR, Cosentino F (1999) Original technique for small colorectal tumor localization during laparoscopic surgery. Dis Colon Rectum 42:819–822PubMedCrossRefGoogle Scholar
  19. 19.
    Ballantyne GH, Leahy PF (2004) Hand-assisted laparoscopic colectomy: evolution to a clinically useful technique. Dis Colon Rectum 47:753–765CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Oded Zmora
    • 1
  • Alexander Lebedyev
    • 1
  • Aviad Hoffman
    • 1
  • Marat Khaikin
    • 1
  • Yaron Munz
    • 1
  • Moshe Shabtai
    • 1
  • Amram Ayalon
    • 1
  • Danny Rosin
    • 1
  1. 1.Department of Surgery and Transplantation, Sheba Medical CenterSackler School of MedicineTel-AvivIsrael

Personalised recommendations