A BSTRACT Surgical site infection (SSI) remains a major cause of morbidity following colorectal surgery, leading to prolonged hospital stay, increased healthcare costs, and delayed adjuvant therapy. Mechanical bowel preparation (MBP) has traditionally been used to reduce infectious complications; however, its clinical value has been increasingly questioned. This study aimed to review the evolution, evidence, and contemporary role of bowel preparation strategies, including MBP alone, oral antibiotics (OA) alone, and combined MBP with OA, in elective colorectal and rectal surgery. A narrative synthesis of randomized controlled trials, systematic reviews, meta-analyses, and large observational studies evaluating bowel preparation strategies in elective colorectal surgery was performed. Key outcomes assessed included SSI, anastomotic leak (AL), length of hospital stay, and readmission rates, with particular emphasis on rectal cancer surgery. High-quality randomized trials and meta-analyses consistently demonstrate that MBP alone does not reduce SSI or AL rates and may be associated with mucosal inflammation, electrolyte imbalance, and patient discomfort. Evidence supporting OA alone remains limited and heterogeneous. In contrast, robust data from randomized studies and large population-based analyses show that the combination of MBP with OA significantly reduces SSI, AL, hospital readmission, and length of hospital stay. These benefits appear more pronounced in rectal cancer surgery, where the baseline risk of pelvic sepsis is higher. MBP should not be used as a standalone intervention in elective colorectal surgery. The combination of MBP with OA offers a clear synergistic benefit and represents the current standard of care.
Theakarajan et al. (Thu,) studied this question.