Bowel Preparation for Colon Surgery Deemed Unnecessary

A new study concludes that mechanical and oral antibiotic bowel preparation (MOABP) prior to surgery does not reduce infection or overall morbidity rates.

Researchers at Helsinki University Hospital (Finland), Oulu University Hospital (Finland), and other institutions conducted a multicenter study involving 417 patients undergoing colon resection, who were randomly assigned to either MOABP (209 patients) or no bowel preparation (NBP; 208 patients). Patients allocated to MOABP were prepared by drinking two liters of polyethylene glycol and one liter of clear fluid on the day before surgery, together with two grams of neomycin and two grams of metronidazole orally. The primary outcome was surgical site infection (SSI) within 30 days after surgery.

After exclusions, the results showed that SSI was detected in 13 (7%) of the 196 patients randomized to MOABP, and in 21 (11%) of the 200 patients randomized to NBP. Anastomotic dehiscence was reported in 4% of the patients in both the MOABP and the NBP group, while reoperations were necessary in 8% of the MOABP group, compared with 7% of the NBP patients. Two patients died in the NBP group and none in the MOABP group within 30 days. The study was published on August 8, 2019, in The Lancet.

“According to our findings, there were no differences in treatment outcomes between the groups. Bowel preparation did not reduce surgical site infections or the total number or severity of surgical complications,” said senior author gastrointestinal surgeon Ville Sallinen, MD, of Helsinki University Hospital. “Neither was there any difference in the number of days spent at the hospital. It appears that this stressful procedure provides no benefit to patients.”

SSI is the most common postoperative complication, occurring in approximately 2-5% of patients who undergo clean extra-abdominal surgeries, such as thoracic and orthopedic surgery, and in up to 20% of patients who undergo intra-abdominal surgery interventions. Besides the pain and suffering to patients, it could lead to catastrophic health expenditure and impoverishment to those patients who are required to pay for their own treatment, and a significant financial burden on healthcare providers.

Related Links:
Helsinki University Hospital
Oulu University Hospital