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Is mechanical bowel preparation mandatory for elective colon surgery? A systematic review and meta-analysis

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Abstract

Background

Growing evidence demonstrates minimal impact of mechanical bowel preparation (MBP) on reducing postoperative complications following elective colectomy. This study investigated the necessity of MBP prior to elective colonic resection.

Method

A systematic literature review was conducted across PubMed, Ovid, and the Cochrane Library to identify studies comparing the effects of MBP with no preparation before elective colectomy, up until May 26, 2023. Surgical-related outcomes were compiled and subsequently analyzed. The primary outcomes included the incidence of anastomosis leakage (AL) and surgical site infection (SSI), analyzed using Review Manager Software (v 5.3).

Results

The analysis included 14 studies, comprising seven RCTs with 5146 participants. Demographic information was consistent across groups. No significant differences were found between the groups in terms of AL ((P = 0.43, OR = 1.16, 95% CI (0.80, 1.68), I2 = 0%) or SSI (P = 0.47, OR = 1.20, 95% CI (0.73, 1.96), I2 = 0%), nor were there significant differences in other outcomes. Subgroup analysis on oral antibiotic use showed no significant changes in results. However, in cases of right colectomy, the group without preparation showed a significantly lower incidence of SSI (P = 0.01, OR = 0.52, 95% CI (0.31, 0.86), I2 = 1%). No significant differences were found in other subgroup analyses.

Conclusion

The current evidence robustly indicates that MBP before elective colectomy does not confer significant benefits in reducing postoperative complications. Therefore, it is justified to forego MBP prior to elective colectomy, irrespective of tumor location.

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Data availability

The data of this manuscript is available in corresponding author by request.

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Authors and Affiliations

  1. Department of General Surgery, Jiangyou Fourth People’s Hospital, Jiangyou, China

    Sheng Liu, Changcheng Wei, Yuehong Wu & Lin Zeng

  2. Department of Stomatology, Jiangyou Fourth People’s Hospital, Jiangyou, China

    Ning Huang

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Contributions

Sheng Liu and Ning Huang wrote the main manuscript text; Changcheng Wei and Yuehong Wu prepared figures and tables. Lin Zeng was responsible for the concept design. All authors reviewed the manuscript.

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Correspondence to Lin Zeng.

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Liu, S., Huang, N., Wei, C. et al. Is mechanical bowel preparation mandatory for elective colon surgery? A systematic review and meta-analysis. Langenbecks Arch Surg 409, 99 (2024). https://doi.org/10.1007/s00423-024-03286-z

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