Selective bowel preparation

Mechanical bowel preparation has long been thought to reduce infectious complications after colorectal resection. However, mechanical bowel preparation is uncomfortable and results in fluid losses. For colon resection, meta-analyses of randomized trials conclude that mechanical bowel preparation does not decrease infectious complications or leak (1). However, these trials did not include oral antibiotics with the mechanical bowel preparation, and North American observational data suggests a decrease in infections when oral antibiotics are added (2). This remains a controversial area and excellent outcomes for colon resection have been reported in ERPs with and without bowel preparation. For colon surgery, oral antibiotics should be added if a mechanical preparation is used. More data are required for rectal surgery.

For more information, see Chapter 5: Bowel Preparation: Always, Sometimes, Never? in The SAGES / ERAS® Society Manual of Enhanced Recovery Programs for Gastrointestinal Surgery

1. Güenaga KF, Matos D, Wille-Jørgensen P. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev. 2011 Sep 7;(9):CD001544.

2. Morris MS, Graham LA, Chu DI, Cannon JA, Hawn MT. Oral Antibiotic Bowel Preparation Significantly Reduces Surgical Site Infection Rates and Readmission Rates in Elective Colorectal Surgery. Ann Surg. 2015 Jan 20. [Epub ahead of print]

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