Bowel Preparation: Always, Sometimes, Never?

Abstract

In conclusion, thorough mechanical cleansing of the bowel has long been considered essential prior to colorectal operations. One believed an empty bowel would diminish the risk of anastomotic leakage and septic complications. However, during the last decade several studies have uniformly concluded that there is no advantage of bowel preparation prior to colonic resections, finding equal or lower rates of anastomotic leakage and septic complications in patients without bowel preparation compared to patients with preoperative bowel preparation. There is some evidence that this conclusion is also valid in the field of rectum surgery; however, more studies are needed. In most enhanced recovery protocols in Europe, full bowel preparation is omitted for colon surgeries including end-colostomies. For rectal cancer surgery some sort of bowel preparation (enema or full mechanical bowel preparation) is still performed.