Bowel prep before colon surgery . . . can we drop it?

Traditionally, patients who were facing colon surgery also faced a difficult process of cleaning the bowel completely with strong laxatives.  However, researchers report in The Lancet that this may not be necessary.

To study whether or not restricted diets and colon cleansing  (mechanical bowel preparation) was necessary to prevent leaking where the colon was rejoined (anastomosis), surgeons at thirteen hospitals in the Netherlands randomly assigned 1,400 patients due to have elective colorectal surgery to either

  • A liquid diet and cleansing laxatives of either polyethylene glycol or sodium phosphate.
  • A normal diet the day before surgery and no laxatives.

There was no significant difference in the rate of anastomotic leaking — 4.8 percent in those who had mechanical bowel preparation versus 5.4 percent who did not.  When there was leaking, there were more abscesses in those patients without bowel preparation:  2 versus 17 without preparation.

There were no differences in other infections, the risk of the surgical wound opening, or mortality.

Caroline ME Contant MD and her colleagues wrote,

We advise that mechanical bowel preparation before elective colorectal surgery can safely be abandoned.

Similar results were found in another, smaller randomized trial of mechanical bowel preparation reported in the Archives of Surgery in 2005.  After that study, Edward Ram MD and his colleagues at Campus Golda in Israel concluded,

Our results suggest that no advantage is gained by preoperative MBP in elective colorectal surgery.

Dr. Ram pointed out that

Mechanical bowel preparation may cause discomfort to the patient, prolonged hospitalization, and water and electrolyte imbalance. It was assumed that with the improvement in surgical technique together with the use of more effective prophylactic antibiotics, it was possible that MBP would no longer be necessary.

However, in cases where colonoscopy during surgery might be necessary, bowel cleansing is important.  In situations where a large tumor might cause a bowel obstruction, mechanical bowel preparation may even be dangerous.

SOURCES Contant et al, The Lancet, Volume 370, Number 9605, December 22, 2007.

Ram et al, Archives of Surgery, Volume 140, Number 3, March 2005.

An additional detailed article about the Ram study is on Medscape, March 22, 2005.

Comments

  1. R Miller says

    A curious conclusion really. The anastomotic leak rate may be similar but if you leak, you get worse sepsis, which will affect colonic funcion in the long term and clearly is not good either in the short term. Surely the conclusion should be that bowel prep minimises the effect of a leak if you get one?

Leave a Reply