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To Prep or Not to Prep

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Current Common Dilemmas in Colorectal Surgery

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Abstract

Oral mechanical bowel preparation is widely employed for elective colorectal surgery. This practice has been popular for many years due to its theoretical impact in reducing infectious complications. Over the last few decades, however, there has been increased scrutiny of these putative benefits. Numerous randomized trials have failed to show any benefit of mechanical bowel preparation in terms of overall infectious complications and more specifically anastomotic leak rates. This has led to several national surgical societies recommending against routine use of bowel preparation in elective colon surgery. Recently, however, several large retrospective reviews analyzing state and national surgical databases have reaffirmed the advantages of mechanical bowel preparation. This review examines these seemingly contradictory results particularly in the setting of a changing surgical environment with increasing adoption of minimally invasive techniques and enhanced recovery programs.

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References

  1. Zmora O, Wexner SD, Hajjar L, et al. Trends in preparation for colorectal surgery: survey of the members of the American Society of Colon and Rectal Surgeons. Am Surg. 2003;69:150–4.

    PubMed  Google Scholar 

  2. Bucher P, Gervaz P, Soravia C, et al. Randomized clinical trial of mechanical bowel preparation versus no preparation before elective left-sided colorectal surgery. Br J Surg. 2005;92:409–14.

    Article  CAS  PubMed  Google Scholar 

  3. Contant CM, Hop WC, van’t Sant HP, et al. Mechanical bowel preparation for elective colorectal surgery: a multicenter randomized trial. Lancet. 2007;370:2112–7.

    Article  PubMed  Google Scholar 

  4. Fa-Si Oen PR, 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. 2005;48:1509–16.

    Article  PubMed  Google Scholar 

  5. Jung B, Pahlman L, Nystrom PO, Nilsson E, Mechanical Bowel Preparation Study Group. Multicentre randomized clinical trial of mechanical bowel preparation in elective colon resection. Br J Surg. 2007;94:689–95.

    Article  CAS  PubMed  Google Scholar 

  6. Cao F, Li J, Li F. Mechanical bowel preparation for elective colorectal surgery: updated systematic review and meta-analysis. Int J Color Dis. 2012;27:803–10.

    Article  CAS  Google Scholar 

  7. Slim K, Vicaut E, Launay-Savary MV, Contant C, Chipponi J. Updated systematic review and meta-analysis of randomized clinical trials on the role of mechanical bowel preparation before colorectal surgery. Ann Surg. 2009;249:203–9.

    Article  PubMed  Google Scholar 

  8. Dahabreh I, Steele DW, Shah N, Trikalinos TA. Oral mechanical bowel preparation for colorectal surgery: systematic review and meta-analysis. Dis Colon Rectum. 2015;58:698–707.

    Article  PubMed  Google Scholar 

  9. Guenaga KE, Matos D, Wille-Jorgensen P. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev. 2011;9:CD001544.

    Google Scholar 

  10. Prevention, diagnosis and management of colorectal anastomotic leakage. The Association of Coloproctology of Great Britain and Ireland. 2016.

    Google Scholar 

  11. Eskicioglu C, Forbes SS, Fenech DS, McLeod RS. Preoperative bowel preparation for patients undergoing elective colorectal surgery: a clinical practice guideline endorsed by the Canadian Society of Colon and Rectal Surgeons. Can J Surg. 2010;53:385–95.

    PubMed  PubMed Central  Google Scholar 

  12. Poon JT, Law WL, Wong IW, et al. Impact of laparoscopic colorectal resection on surgical site infection. Ann Surg. 2009;249:77–81.

    Article  PubMed  Google Scholar 

  13. Vignali A, Fazio VW, Lavery IC, et al. Factors associated with the occurrence of leaks in stapled rectal anastomoses. J Am Coll Surg. 1997;185:105–13.

    Article  CAS  PubMed  Google Scholar 

  14. Adelaide Murray AC, Pasam R, Estrada D, Kiran RP. Risk of surgical site infection varies based on location of disease and segment of colorectal resection for cancer. Dis Colon Rectum. 2016;59:493–500.

    Article  Google Scholar 

  15. Bretagnol F, Panis Y, Rullier E, et al. Rectal cancer surgery with or without bowel preparation: the French GRECCAR III multicenter single-blinded randomized trial. Ann Surg. 2010;252:863–8.

    Article  PubMed  Google Scholar 

  16. Van’t Sant HP, Weidema WF, Hop WC, et al. The influence of mechanical bowel preparation in elective lower colorectal surgery. Ann Surg. 2010;251:59–63.

    Article  PubMed  Google Scholar 

  17. Courtney DE, Kelly ME, Burke JP, Winter DC. Postoperative outcomes following mechanical bowel preparation before proctectomy: a meta-analysis. Color Dis. 2015;17:862–9.

    Article  CAS  Google Scholar 

  18. Kiran RP, Murray AC, Chiuzan C, et al. Combined preoperative mechanical bowel preparation with oral antibiotics significantly reduces surgical site infection rates, anastomotic leak and ileus after colorectal surgery. Ann Surg. 2015;262:416–25.

    Article  PubMed  Google Scholar 

  19. Morris MS, Graham DI, Chu JA, et al. Oral antibiotic bowel preparation significantly reduces surgical site infection rates and readmission rates in elective colorectal surgery. Ann Surg. 2015;261:1034–40.

    Article  PubMed  Google Scholar 

  20. Lewis RT. Oral versus systemic antibiotic prophylaxis in elective colon surgery. Can J Surg. 2002;45:173–80.

    PubMed  PubMed Central  Google Scholar 

  21. Cannon JA, Altom LK, Deierhoi RJ, et al. Preoperative oral antibiotics reduce surgical site infection following elective colorectal resections. Dis Colon Rectum. 2012;55:1160–6.

    Article  PubMed  Google Scholar 

  22. Englesbe MJ, Brooks L, Kubus J, et al. A statewide assessment of surgical site infection following colectomy: the role of oral antibiotics. Ann Surg. 2010;252:514–9.

    PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Rhode Island Hospital, Providence, RI, USA

    Nishit Shah

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  1. Nishit Shah
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Correspondence to Nishit Shah .

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Editors and Affiliations

  1. London Health Sciences Centre, University Hospital, London, Ontario, Canada

    Christopher M. Schlachta

  2. Mount Sinai School of Medicine, New York, New York, USA

    Patricia Sylla

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Shah, N. (2018). To Prep or Not to Prep. In: Schlachta, C., Sylla, P. (eds) Current Common Dilemmas in Colorectal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-70117-2_1

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  • DOI: https://doi.org/10.1007/978-3-319-70117-2_1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-70116-5

  • Online ISBN: 978-3-319-70117-2

  • eBook Packages: MedicineMedicine (R0)

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