Preoperative bowel preparation

For more than a century, the presence of unprepped bowel during surgery was believed to increase anastomotic leakage and infection rates. Logically, preoperative mechanical bowel preparation could reduce fecal flora and thus lower the risk of anastomotic leakage and infection. As such, this dogma has been passed down through the years on the basis of expert opinion and not scientific studies. In a review by Guenaga et al of 13 prospective randomized trials that included 4777 patients who underwent large bowel resection, anastomotic leakage occurred in 4% of the patients with a preoperative mechanical bowel preparation, compared with 3% of the patients with no preparation ( P = .15). Wound infection occurred in 10% of the patients with preparation, compared with 8% of the patients with no preparation ( P = .09). The authors concluded that the notion that mechanical bowel preparation is necessary before elective colorectal surgery should be reconsidered. The Canadian Society of Colon and Rectal Surgeons recommends that preoperative mechanical bowel preparation should be omitted.

Similarly, preoperative oral antibiotic bowel preparation is associated with increased nausea, vomiting, and abdominal pain and does not decrease postoperative infections and therefore is not recommended.

Although preoperative mechanical bowel preparation should be omitted for elective abdominal cases, there is controversy as to whether its use before advanced gynecologic laparoscopic procedures improves the visibility of the surgical field. In a prospective randomized trial of 162 patients who underwent gynecologic laparoscopic procedures, oral sodium phosphate did not improve the quality of the surgical field. Unfortunately, randomized data on this topic are limited.