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Mechanical Bowel Preparation or Not? Outcome of a Multicenter, Randomized Trial in Elective Open Colon Surgery

  • Original Contribution
  • Published:
Diseases of the Colon & Rectum

PURPOSE

Mechanical bowel preparation is common practice in elective colon surgery. In recent literature the value of this procedure is under discussion. To verify the value of mechanical bowel preparation in elective open colon surgery, a randomized clinical trial was conducted.

METHODS

During a prospective, multicenter, randomized study, 250 patients undergoing elective open colon surgery were randomized between receiving mechanical bowel preparation with polyethylene glycol (PEG group, 125 patients) and having a normal meal preoperatively (normal meal preoperatively group, 125 patients). Outcome parameters were wound infection with bacterial results of intraoperative swabs and anastomotic leak.

RESULTS

In the polyethylene glycol group there were a total of nine wound infections (7.2 percent) and seven anastomotic leaks (5.6 percent) compared with seven wound infections (5.6 percent) (P = 0.61) and six anastomotic leaks (4.8 percent) (P = 0.78) in the normal meal preoperatively group. Bacterial results showed 52 percent sterile subcutis swabs in the PEG group and 63 percent sterile subcutis swabs in the normal meal preoperatively group (P = 0.11).

CONCLUSION

In the pres-ent study we could not detect a difference in outcome parameters between patients receiving mechanical bowel preparation in elective open colon surgery and patients without preoperative treatment of the bowel. The present study, although underpowered, did not show a difference in the primary outcome of bacterial wound cultures between patients receiving preoperative mechanical bowel preparation and patients receiving no preoperative bowel treatment. We conclude that there may be no need to continue the use of mechanical bowel preparation in elective open colon surgery.

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ACKNOWLEDGMENTS

The authors thank Elma Klein–Kranenbarg and the team of the data center of the Leiden University Medical Center.

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Authors and Affiliations

  1. Department of Surgery, Maxima Medical Center, Veldhoven, The Netherlands

    Patrick Fa-Si-Oen M.D., Rudi Roumen M.D., Ph.D., John Buitenweg M.D. & Fred Croiset van Uchelen M.D., Ph.D.

  2. Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands

    Cornelis van de Velde M.D., Ph.D.

  3. Department of Surgery, Isala Clinics, Zwolle, The Netherlands

    Dick van Geldere M.D., Ph.D.

  4. Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands

    Hein Putter Ph.D.

  5. Department of Intensive Care Medicine, University Hospital Gasthuisberg, Leuven, Belgium

    Charles Verwaest M.D., Ph.D.

  6. Department of Microbiology, Maxima Medical Center, Veldhoven, The Netherlands

    Loes Verhoef M.D., Ph.D.

  7. Department of Surgery, Westfries Gasthuis, Hoorn, The Netherlands

    Jan-Willem de Waard M.D., Ph.D.

  8. Department of Surgery, Groene Hart Hospital, Gouda, The Netherlands

    Dingeman Swank M.D., Ph.D.

  9. Department of Surgery, University Hospital Gasthuisberg, Leuven, Belgium

    Andre D’Hoore M.D.

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  1. Patrick Fa-Si-Oen M.D.
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Correspondence to Rudi Roumen M.D., Ph.D..

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Fa-Si-Oen, P., Roumen, R., Buitenweg, J. et al. Mechanical Bowel Preparation or Not? Outcome of a Multicenter, Randomized Trial in Elective Open Colon Surgery. Dis Colon Rectum 48, 1509–1516 (2005). https://doi.org/10.1007/s10350-005-0068-y

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