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Evidence summaries

Mechanical Bowel Preparation for Elective Colorectal Surgery

Mechanical bowel preparation for elective colorectal surgery may not decrease postoperative complications. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 18 studies with a total of 5805 subjects. All studies compared mechanical bowel preparation (MBP) with no preparation. The included studies used different MBP methods (polyethylene glycol electrolyte solution, sodium phosphate solution, mannitol, enemas, laxatives, and diets). There were no differences in anastomotic leakage stratified for rectal or colonic surgery; leakage rates for low anterior resection were 8.8% in MBP vs. 10.3% in no preparation group (Peto OR 0.88, 95% CI 0.55 to 1.40), and for colonic surgery 3.0% in MBP vs. 3.5% in no preparation group (Peto OR 0.85, 95% CI 0.58 to 1.26).

For colorectal surgery overall, no differences were found in anastomotic leakage (Peto OR 0.93, 95% CI 0.34 to 2.52) and in wound infections (Peto OR 1.26, 95% CI 0.85 to 1.88).

Comment: The quality of evidence is downgraded by inconsistency (heterogeneity of results in different outcomes) and by imprecise results (wide confidence intervals).

    References

    • Güenaga KF, Matos D, Wille-Jørgensen P. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev 2011;(9):CD001544. [PubMed]

Primary/Secondary Keywords