Mechanical bowel preparation in elective colorectal surgery

Abstract

Objectives: To assess the effects of preoperative mechanical bowel preparation (MBP) on postoperative complications and recovery in elective colorectal surgery. Material and Methods: Prospective study carried out in the Surgical Department of Hayatabad Medical Complex on patients with American Society of Anaesthesiologist (ASA) grade < III, undergoing elective bowel resection and primary anastomosis for colorectal pathology. Post operative anastomotic leak, re-operation rate and mortality within a 30 day period were determined as the primary end points while the secondary endpoints were wound infections, abscesses, cardiovascular complications and hospital stay. Results: A total of 102 patients were randomized into two groups. Half of these (MBP-Gp1) received mechanical bowel preparation prior to surgery and the other half (No MBP-Gp2) did not have any bowel preparation. No significant difference was observed between the two groups in relation to the primary and secondary endpoints with the rate of anastomotic leak recorded as 11.76% and 7.84%, re-operation rate 9.8% and 5.88%, mortality 1.96% and 1.96%, cardiovascular complications 19.61% and 11.76%, wound infection 23.5% and 15.69% and deep abscess 7.84% and 3.92% respectively. Post-operative hospital stay was 10.27 d in Gp1 and 10.02 d in group 2, the difference being statistically insignificant. Conclusions: Mechanical bowel preparation offers no benefit in terms of anastomotic leak rate, infective and other complications in patients undergoing elective colorectal procedures.