The use of mechanical bowel preparation in elective colorectal surgery

BACKGROUND: Mechanical bowel preparation (MBP) prior to elective colorectal surgery has been in use for many years. It is considered important in preventing post-operative infectious complications after colorectal surgery. The evidence to support these claims is lacking within the medical literature and yet this still remains standard practice in many hospitals. A literature search was undertaken to ascertain the evidence available regarding the use of MBP in elective colorectal surgery. METHODS: The search included the databases PubMed, Medline and Embase using the keywords “mechanical bowel preparation”, “bowel cleansing” and “elective colorectal surgery”, a search of recent issues of relevant journals including Diseases of the Colon and Rectum and British Journal of Surgery and backward chaining from articles obtained. RESULTS AND CONCLUSION: Most authors recommend that colorectal surgery is safe without pre-operative MBP but that there may some situations in which it may be beneficial (e.g. if there is a small tumour or the possible need for intra-operative colonoscopy). The implication for clinical practice in this situation is that there is not enough strength of evidence at present to recommend a change in practice. There is a need for further higher powered trials to try to answer this question definitively.