A clinical and physiological evaluation of bowel preparation for elective colorectal surgery

Abstract Efficient mechanical bowel preparation is essential for satisfactory double‐contrast barium enema and colonoscopy. Satisfactory mechanical preparation is also important for reducing the risk of anastomotic dehiscence and sepsis in elective colorectal surgery. Traditional mechanical preparation by fasting, purgation, and enemas is timeconsuming, unpleasant for patients and nursing staff, and in our center, results in a perfect preparation in only 23% of patients. Elemental diets are expensive and inefficient when used for only 5 days. Whole bowel irrigation involves the use of a nasogastric tube and provides a rapid preparation with a perfect result in 61% of patients, but is not recommended for patients with stenosing tumors. Furthermore, irrigation with saline causes sodium and water retention which may precipitate heart failure in the elderly unless preceded by furosemide. The use of a balanced electrolyte solution reduces the risk of these side effects. Recently, oral irrigation with mannitol has become popular, but in our experience, results in a perfect preparation in only 41% of patients unless followed by a short saline lavage (85% satisfactory). Mannitol also produces potentially explosive gas mixtures by bacterial fermentation unless oral antimicrobials (neomycin and metronidazole) are used immediately before operation. Therefore, we recommend mannitol, saline lavage, and antibiotics in most cases, but still find a place for traditional preparation over 5 days for patients with tumors associated with severe stenosis of the left colon .