Key result
Mechanical bowel preparation provided no significant reduction in overall anastomotic leakage compared to no preparation (OR 0.99) in patients undergoing elective colorectal surgery.
Why the study?
The belief that mechanical bowel preparation prevents anastomotic leakage and infectious complications during colorectal surgery was based only on observational data and expert opinions.
Does mechanical bowel preparation reduce anastomotic leakage and wound infection in patients undergoing elective colorectal surgery?
Meta-Analysis (n=5,805)
Yes
Does mechanical bowel preparation reduce anastomotic leakage and wound infection in patients undergoing elective colorectal surgery?
Mechanical bowel preparation alone confers no advantage over no preparation or rectal enema in preventing anastomotic leakage or infectious complications in elective colorectal surgery.
Supports omitting routine mechanical bowel preparation before elective colorectal surgery; confirms no advantage for anastomotic or infectious outcomes.
Background The presence of bowel contents during colorectal surgery has been related to anastomotic leakage, but the belief that mechanical bowel preparation (MBP) is an efficient agent against leakage and infectious complications is based on observational data and expert opinions only. Objectives To determine the security and effectiveness of MBP on morbidity and mortality in colorectal surgery. Search methods Publications describing trials of MBP before elective colorectal surgery were sought through searches of MEDLINE, EMBASE, LILACS, IBECS and The Cochrane Library. Searches were performed December 1, 2010. Selection criteria Randomized controlled trials (RCTs) including participants submitted for elective colorectal surgery. Main results For the comparison mechanical bowel preparation (Group A) versus no mechanical bowel preparation (Group B) results were: (1) anastomotic leakage for low anterior resection: 8.8% (38/431) of Group A, compared with 10.3% (43/415) of Group B; Peto OR 0.88 [0.55, 1.40]. (2) Anastomotic leakage for colonic surgery: 3.0% (47/1559) of Group A, compared with 3.5% (56/1588) of Group B; Peto OR 0.85 [0.58, 1.26]. (3) Overall anastomotic leakage: 4.4% (101/2275) of Group A, compared with 4.5% (103/2258) of Group B; Peto OR 0.99 [0.74, 1.31]. (4) Wound infection: 9.6% (223/2305) of Group A, compared with 8.5% (196/2290) of Group B; Peto OR 1.16 [0.95, 1.42]. Sensitivity analyses did not produce any differences in overall results. For the comparison mechanical bowel preparation (A) versus rectal enema (B) results were: (1) anastomotic leakage after rectal surgery: 7.4% (8/107) of Group A, compared with 7.9% (7/88) of Group B; Peto OR 0.93 [0.34, 2.52]. (2) Anastomotic leakage after colonic surgery: 4.0% (11/269) of Group A, compared with 2.0% (6/299) of Group B; Peto OR 2.15 [0.79, 5.84]. (3) Overall anastomotic leakage: 4.4% (27/601) of Group A, compared with 3.4% (21/609) of Group B; Peto OR 1.32 [0.74, 2.36]. (4) Wound infection: 9.9% (60/601) of Group A, compared with 8.0% (49/609) of Group B; Peto OR 1.26 [0.85, 1.88]. Authors’ conclusions There is no statistically significant evidence that patients benefit from mechanical bowel preparation, nor the use of rectal enemas. Further research on patients having elective rectal surgery, below the peritoneal reflection, in whom bowel continuity is restored, and studies with patients having laparoscopic surgery are still warranted.
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Lewis et al. (2019) conducted a meta-analysis in elective colorectal surgery (n=5,805). Mechanical bowel preparation vs. No mechanical bowel preparation was evaluated on Overall anastomotic leakage (Peto OR 0.99, 95% CI 0.74, 1.31). Mechanical bowel preparation provided no significant reduction in overall anastomotic leakage compared to no preparation (OR 0.99) in patients undergoing elective colorectal surgery.
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