Techniques in Coloproctology

, Volume 15, Supplement 1, pp 59–62 | Cite as

Mechanical bowel preparation before elective colorectal surgery: is it necessary?

  • A. MatsouEmail author
  • G. Vrakas
  • M. Doulgerakis
  • K. Hatzimisios
  • N. Zandes
  • K. Saliangas



To present the worldwide accepted guidelines concerning the use of mechanical bowel preparation (MBP) before elective colorectal surgery (ECS).

Patients and methods

We conducted a retrospective review of the Pubmed Databases for randomized controlled trials (RCTs) and meta-analyses, which included adult patients who underwent elective colorectal surgery. We compared the patients who had a preoperative MBP with those who did not. Significant factors that were taken into account were postoperative septic complications and anastomotic dehiscence.


Our search revealed 5 RCTs and 2 meta-analyses that met our criteria. Patients who underwent emergency colorectal surgery were excluded from the study. We identified the recommendations for 6 different types of elective colorectal surgery.


MBP has been for many years a standard clinical procedure for patients undergoing elective colorectal surgery. However, many recent researches suggest the omission of MBP, since there are no significant differences regarding postoperative infectious complications, such as anastomotic dehiscence and superficial surgical site infections. Furthermore, MBP is a time-consuming, expensive procedure and causes severe discomfort to the patient. More importantly, the application of MBP has been associated with serious complications in both healthy patients and patients with existing cardiac or renal disease, such as electrolyte and volume disturbances.


Mechanical bowel preparation (MBP) Elective colorectal surgery (ECS) Anastomotic dehiscence 


Conflict of interest

The authors declare that they have no conflict of interest related to the publication of this article.


  1. 1.
    Chambers WM, Mortensen NJ (2004) Postoperative leakage and abscess formation after colorectal surgery. Best Pract Res Clin Gastroenterol 18:865–880PubMedGoogle Scholar
  2. 2.
    Soeters PB, de Zoete JP, Dejong CH et al (2002) Colorectal surgery and anastomotic leakage. Dig Surg 19:150–155PubMedCrossRefGoogle Scholar
  3. 3.
    Fa-Si-Oen PR, Verwaest C, Buitenweg J et al (2005) Effect of mechanical bowel preparation with polyethyleneglycol on bacterial contamination and wound infection in patients undergoing elective open colon surgery. Clin Microbiol Infect 11:158–160PubMedCrossRefGoogle Scholar
  4. 4.
    Zmora O, Wexner SD, Hajjar L et al (2003) Trends in preparation for colorectal surgery: survey of the members of the American society of colon and rectal surgeons. Am Surg 69:150–154PubMedGoogle Scholar
  5. 5.
    Slim K, Vicaut E, Panis Y et al (2004) Meta-analysis of randomised clinical trials of colorectal surgery with or without mechanical bowel preparation. Br J Surg 91:1125–1130PubMedCrossRefGoogle Scholar
  6. 6.
    Bretagnol F, Alves A, Ricci A et al (2007) Rectal cancer surgery without mechanical bowel preparation. Br J Surg 94:1266–1271PubMedCrossRefGoogle Scholar
  7. 7.
    Eskicioglu C, Forbes SS, Fenech DS et al (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 53:385–395PubMedGoogle Scholar
  8. 8.
    Contant CM, Hop WCJ, van’t Sant HP et al (2007) Mechanical bowel preparation for elective colorectal surgery: a multicentre randomized trial. Lancet 370:2112–2117PubMedCrossRefGoogle Scholar
  9. 9.
    Pena-Soria MJ, Mayol JM, Anula R et al (2008) Single-blinded randomized trial of mechanical bowel preparation for colon surgery with primary intraperitoneal anastomosis. J Gastrointest Surg 12:2103–2109PubMedCrossRefGoogle Scholar
  10. 10.
    Bucher P, Gervaz P, Soravia C et al (2005) Randomized clinical trial of mechanical bowel preparation versus no preparation before elective left-sided colorectal surgery. Br J Surg 92:409–414PubMedCrossRefGoogle Scholar
  11. 11.
    Jung B, Pahlman L, Nystrom PO et al (2007) Multicentre randomized clinical trial of mechanical bowel preparation in elective colonic resection. Br J Surg 94:689–695PubMedCrossRefGoogle Scholar
  12. 12.
    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 48:1509–1516PubMedCrossRefGoogle Scholar
  13. 13.
    Slim K, Vicaut E, Launay-Savary M et al (2009) Updated systematic review and meta-analysis of randomized clinical trials on the role of mechanical bowel preparation before colorectal surgery. Ann Surg 249:203–209PubMedCrossRefGoogle Scholar
  14. 14.
    Pineda CE, Shelton AA, Hernandez-Boussard T et al (2008) Mechanical bowel preparation in intestinal surgery: a meta analysis and review of the literature. J Gastrointest Surg 12:2037–2044PubMedCrossRefGoogle Scholar
  15. 15.
    Berg RD (1999) Bacterial translocation from the gastrointestinal tract. Adv Exp Med Biol 473:11–30PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • A. Matsou
    • 2
    • 1
    Email author
  • G. Vrakas
    • 1
  • M. Doulgerakis
    • 1
  • K. Hatzimisios
    • 1
  • N. Zandes
    • 1
  • K. Saliangas
    • 1
  1. 1.Surgical DepartmentGeneral District Hospital “Mamatseio”KozaniGreece
  2. 2.ThessalonikiGreece

Personalised recommendations