Bowel preparation for colorectal surgery

This issue of the Journal contains a paper by Irving and Scrimgeour which challenges accepted surgical practice (pages 58Cr581). It is a veritable little bomb of a paper, brief, iconoclastic, and disrespectful of hallowed tradition in colorectal surgery. The authors argue that pre-operative bowel preparation is timeconsuming and expensive, unpleasant to the patient -even dangerous on occasionsand completely unnecessary. They point out, correctly, that it is impossible to sterilize the bowel, and that the solid contents of unprepared bowel are easier to deal with at operation than the liquid contents of ill-prepared bowel. Provided that a single dose of 'appropriate' antibiotics (cefuroxime and metronidazole) is administered intravenously at the start of the operation, they claim that pre-operative bowel preparation both by mechanical methods and by the use of oral antibiotics may be omitted. Their comments on bowel preparation aside, it is all stirring stuff, terse and decisive: 'drains and colostomies were never used' and 'free oral fluids were encouraged within the first 24 h'.