Diseases of the Colon & Rectum

, Volume 33, Issue 2, pp 154–159 | Cite as

Preoperative bowel preparation

A survey of colon and rectal surgeons
  • Julio A. Solla
  • David A. Rothenberger
Current Status


A survey of 500 clinically active, board-certified colon and rectal surgeons in the United States and Canada was conducted to obtain data regarding current methods of bowel preparation for elective colorectal surgery. A review of recent publications on preoperative bowel preparation was used to compare the current literature recommendations with the actual practice among the group surveyed. Responses were received from 352 of 500 colorectal surgeons to whom questionnaires were sent (70 percent response rate). All respondents used a mechanical preparation and some form of antibiotics. The favorite antibiotic regimen was oral antimicrobials combined with systemic antibiotics (88 percent). Concomitant administration of oral neomycin-erythromycin base and a systemic second generation cephalosporin active against both anaerobic and aerobic colonic bacteria, together with oral polyethelene glycol electrolyte mechanical colonic cleansing, was the most popular method of preoperative bowel preparation (58 percent). The second most frequent method of mechanical bowel cleansing consisted of conventional enemas, dietary restrictions, and cathartic preparations (36 percent). Mannitol solution (5 percent), and whole-gut irrigation per nasogastric tube (1 percent) were the least popular methods of mechanical bowel cleansing. The literature supports the current methods of preoperative bowel preparation used by the vast majority of surgeons surveyed.

Key words

Bowel preparation colonic cleansing Prophylactic antibiotics 


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  1. 1.
    Nichols RL, Condon RE. Preoperative preparation of the colon. Surg Gynecol Obstet 1971;132:323–37.Google Scholar
  2. 2.
    Baum ML, Anish DS, Chalmer TC, Sacks H, Smith H, Fagerstrom RM. A survey of clinical trials of antibiotics prophylaxis in colon surgery: evidence againt further use of no-treatment controls. N Engl J Med 1981;305:795–9.PubMedGoogle Scholar
  3. 3.
    Munster AM, Weiner J, Gibson G. Prophylactic antibiotics in surgery. JAMA 1979;241:717–8.PubMedGoogle Scholar
  4. 4.
    Hoffman CE, McDonald PJ, Watts JM. Use of preoperative cefoxitin to prevent infection after colonic and rectal surgery. Ann Surg 1981;193:353–6.PubMedGoogle Scholar
  5. 5.
    Clark JS, Condon RE, Bartlett JG, Gorbach SL, Nichols RL, Ochi S. Preoperative oral antibiotics reduce septic complications of colon operations: results of prospective, randomized, double blind clinical study. Ann Surg 1977;186:251–8.PubMedGoogle Scholar
  6. 6.
    Hewitt J, Rigby J, Reeve J, Cox AG. Whole-gut irrigation in preparation for large bowel surgery. Lancet 1973;2:337–40.PubMedGoogle Scholar
  7. 7.
    Chung RS, Gurll NJ, Berglund EM. A controlled clinical trial of whole-gut lavage as a method of bowel preparation for colonic surgery. Am J Surg 1979;137:75–81.PubMedGoogle Scholar
  8. 8.
    Panton ON, Atkinson KG, Crichton EP, Schulzer M, Beaufoy A, Germann E. Mechanical preparation of the large bowel for elective surgery: comparison of whole-gut lavage with the conventional enema and purgative technique. Am J Surg 1985;149:615–9.PubMedGoogle Scholar
  9. 9.
    Gottrup F, Diederich P, Sorensen K, Nielsen SV, Ornsholt J, Brandsborg O. Prophylaxis with whole-gut irrigation and antimicrobials in colorectal surgery: a prospective, randomized double-blind clinical trial.Google Scholar
  10. 10.
    Keighley MR, Taylor EW, Hares MM. Influences of oral mannitol bowel preparation on colonic microflora and the risk of explosion during endoscopy diathermy. Br J Surg 1981;68:554–8.PubMedGoogle Scholar
  11. 11.
    Hare MM, Alexander-Williams J. The effect of bowel preparation on colonic surgery. World J Surg 1982;6:175–81.PubMedGoogle Scholar
  12. 12.
    Jagelman DG, Fazio VW, Lavery IC, Weakley FL. A prospective, randomized, double blind study of 10% mannitol mechanical bowel preparation combined with oral neomycin and shortterm, preoperative, intravenous flagyl as prophylaxis in elective colorectal resections. Surgery 1985;98:861–5.PubMedGoogle Scholar
  13. 13.
    Bigard MA, Gaucher P, Lassalle C. Fatal colonic explosion during colonoscopic polypectomy. Gastroenterology 1979;77:1307–10.PubMedGoogle Scholar
  14. 14.
    David GR, SantaAna CA, Morawski SG, Fordtran JS. Development of a lavage solution associated with minimal water and electrolyte absorption or secretion. Gastroenterology 1980;78:991–5.PubMedGoogle Scholar
  15. 15.
    Boweden TA, DiPira JT, Micael KA. Polyethylene glycol electrolyte solution: a rapid, safe mechanical bowel preparation for colorectal surgery. Am Surg 1987;53:34–6.PubMedGoogle Scholar
  16. 16.
    Beck DE, Harford FJ, Di Palma JA. Comparison of cleansing methods in preparation for colonic surgery. Dis Colon Rectum 1985;28:491–5.PubMedGoogle Scholar
  17. 17.
    Dueholm S, Rubinstein E, Reipurth G. Preparation for elective colorectal surgery: a randomized, blinded comparison between oral colonic lavage and whole-gut irrigation. Dis Colon Rectum 1987;30:360–4.PubMedGoogle Scholar
  18. 18.
    Polk HC, Lopez-Mayor JF. Postoperative wound infection: a prospective study of determinant factors and prevention. Surgery 1969;66:97–103.PubMedGoogle Scholar
  19. 19.
    Kelly MJ. Wound infection: a controlled clinical experimental demonstration of synergy between aerobic Escherichia coli and anaerobic Bacteroides fragilis bacteria. Ann R Coll Surg Engl 1980;62:52–9.PubMedGoogle Scholar
  20. 20.
    De La Hunt MN, Karran SJ. Sulbactum/ampicillin compared with cefoxitin for chemoprophylaxis in elective colorectal surgery. Dis Colon Rectum 1986;29:157–9.PubMedGoogle Scholar
  21. 21.
    McDonald PJ, Karran SJ. A comparison of intravenous cefoxitin and a combination of gentamicin and metronidazole as prophylaxis in colorectal surgery. Dis Colon Rectum 1983;26:661–4.PubMedGoogle Scholar
  22. 22.
    Panichi G, Pantosi A, Giunchi G, et al. Cephalothin, cefoxitin, or metronidazole in elective colonic surgery? A single-blind randomized trial. Dis Colon Rectum 1982;25:783–6.PubMedGoogle Scholar
  23. 23.
    Miltermayer H, Gross C, Brucke P. Single dose cefurozime/metronidazole versus metronidazole alone in elective colorectal surgery. Am Surg 1984;50:418–23.PubMedGoogle Scholar
  24. 24.
    The Norwegian study group for colorectal surgery. Surgery 1985;94:402–8.Google Scholar
  25. 25.
    Coppa GE, Eng K, Gouge TH, Ranson JH, Localio SA. Parenteral and oral antibiotics in elective colon and rectal surgery. Am J Surg 1983;145:62–5.PubMedGoogle Scholar
  26. 26.
    Stone HH, Hooper CA, Kolb LD, Geheber CE, Dawkins JE. Antibiotic prophylaxis in gastric, biliary and colonic surgery. Ann Surg 1976;184:443–40.PubMedGoogle Scholar
  27. 27.
    Kaiser AB, Herrington JL, Jacobs JK, Mulherin JL, Roach AC, Sawyers JL. Cefoxitin vs erythromycin, neomycin and cefazolin in colorectal surgery: importance of the duration of the operative procedure. Ann Surg 1983;198:525–30.PubMedGoogle Scholar
  28. 28.
    Willis AT, Ferguson IR, Jones PH, Phillips KD, Tearle PV, Fiddian RV. Metronidazole in prevention and treatment of bacteroides infections in elective colonic surgery. Br Med J 1977;1:607–10.PubMedGoogle Scholar
  29. 29.
    Hanel KC, King DW, McAllister ET, Reiss-Levy E. Single-dose parenteral antibiotics as prophylaxis against wound infections in colonic operations. Dis Colon Rectum 1980;23:98–101.PubMedGoogle Scholar
  30. 30.
    Keighley MR. A clinical and physiological evaluation of bowel preparation for elective colorectal surgery. World J Surg 1982;6:464–70.PubMedGoogle Scholar
  31. 31.
    Peck JJ, Fuchs PC, Gustafson ME. Antimicrobial prophylaxis in elective colon surgery: experience of 1,035 operations in a community hospital. Am J Surg 1984;147:633–7.PubMedGoogle Scholar
  32. 32.
    Portnoy J, Kagan E, Gordon PH, Mendelson J. Prophylactic antibiotics in elective colorectal surgery. Dis Colon Rectum 1983;26:310–13.PubMedGoogle Scholar
  33. 33.
    Pello JM, Beauregard W, Shaika K, Camishion RC. Colon operations without wound infection: principles and techniques of 101 cases. Am Surg 1984;50:362–5.PubMedGoogle Scholar
  34. 34.
    Lazorthes F, Legrand G, Monrozies X, et al. Comparison between oral and systemic antibiotics and their combined use for the prevention of complications in colorectal surgery. Dis Colon Rectum 1982;25:309–11.PubMedGoogle Scholar
  35. 35.
    Condon RE. Bowel preparation for colorectal operations. Arch Surg 1982;117:265.PubMedGoogle Scholar
  36. 36.
    Condon RE, Bartlett JG, Nichols RL, Schulte WJ, Gorbach SL, Ochi S. Preoperative prophylactic cephalothin fails to control septic complications of colorectal operations: results of controlled clinical trial. A Veterans Administration cooperative study. Am J Surg 1979;137:58–74.Google Scholar
  37. 37.
    Condon RE, Bartlett JG, Greenlee H, et al. Efficacy of oral and systemic antibiotic prophylaxis in colorectal operations. Arch Surg 1983;118:496–502.PubMedGoogle Scholar
  38. 38.
    Condon RE. Antibiotic bowel preparation for surgery. Confronting Infection, Cases and Commentary. Wilmington: Stuart Pharmaceuticals, 1987;5:1–12.Google Scholar
  39. 39.
    Barber MS, Hirschberg BC, Rice CL, Atkins CC. Parenteral antibiotics in elective controlled trial. Surgery 1979;86:23–8.PubMedGoogle Scholar
  40. 40.
    Brown JJ, Mutton TP, Wasilauskas BL, Myers RT, Meredith JH. Prospective, randomized, controlled trial of ticarcillin and cephalothin as prophylactic antibiotics for gastrointestinal operations. Am J Surg 1982:143:343–8.PubMedGoogle Scholar
  41. 41.
    Eisenberg HW. The use of new antibiotics in colorectal surgery. Am J Proctol 1981;32:9–26.Google Scholar

Copyright information

© American Society of Colon and Rectal Surgeons 1990

Authors and Affiliations

  • Julio A. Solla
    • 1
  • David A. Rothenberger
    • 1
  1. 1.Department of Surgery, Colon and Rectal SurgeryUniversity of MinnesotaMinneapolis

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