This Article  • Full text  • PDF  • Notice of Duplicate Publication  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citing articles on HighWire  • Citing articles on Web of Science (34)  • Contact me when this article is cited  Related Content  • Related articles  • Similar articles in this journal  Topic Collections  • Evidence-Based Medicine  • Colorectal Surgery  • Alert me on articles by topic  Social Bookmarking   What's this?

A Meta-analysis

Pascal Bucher, MD; Bernadette Mermillod, BS; Pascal Gervaz, MD; Philippe Morel, MD

Arch Surg. 2004;139:1359-1364.

Hypothesis  There is little scientific evidence to support the routine practice of mechanical bowel preparation (MBP) before elective colorectal surgery in order to minimize the risk of postoperative septic complications.

Data Sources  Trials were retrieved using a MEDLINE search followed by a manual search of the bibliographic information in select articles. Languages were restricted to English, French, Spanish, Italian, and German. There was no date restriction.

Study Selection  Only prospective randomized clinical trials (RCTs) evaluating MBP vs no MBP before elective colorectal surgery were included.

Data Extraction  Outcomes evaluated were anastomotic leakage, intra-abdominal infection, wound infection, reoperation, and general and extra-abdominal morbidity and mortality rates. Data were extracted by 2 independent observers.

Data Synthesis  Seven RCTs were retrieved. The total number of patients in these RCTs was 1297 (642 who had received MBP and 655 who had not). Among all the RCTs reviewed, anastomotic leak was significantly more frequent in the MBP group, 5.6% (36/642), compared with the no-MBP group, 2.8% (18/655) (odds ratio, 1.84; P = .03). Intra-abdominal infection (3.7% for the MBP group vs 2.0% for the no-MBP group), wound infection (7.5% for the MBP group vs 5.5% for the no-MBP group), and reoperation (5.2% for the MBP group vs 2.2% for the no-MBP group) rates were nonstatistically significantly higher in the MBP group. General morbidity and mortality rates were slightly higher in the MBP group.

Conclusions  There is no evidence to support the use of MBP in patients undergoing elective colorectal surgery. Available data tend to suggest that MBP could be harmful with respect to the incidence of anastomotic leak and does not reduce the incidence of septic complications.

Author Affiliations: Clinic of Visceral and Transplantation Surgery, Department of Surgery (Drs Bucher, Gervaz, and Morel) and Division of Medical Statistics (Ms Mermillod), Geneva University Hospital, Geneva, Switzerland.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLES

This Month in Archives of Surgery
Arch Surg. 2004;139(12):1275.
FULL TEXT  

Mechanical Bowel Preparation for Elective Colorectal Surgery—Invited Critique
Jack Pickleman
Arch Surg. 2004;139(12):1365.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Multidisciplinary Management of Patients with Advanced Rectal Cancer
Beart
Clin. Cancer Res. 2007;13:6890s-6893s.
ABSTRACT | FULL TEXT  

The Role of the Anesthesiologist in Fast-Track Surgery: From Multimodal Analgesia to Perioperative Medical Care
White et al.
Anesth. Analg. 2007;104:1380-1396.
ABSTRACT | FULL TEXT  

Povidone-Iodine vs Sodium Hypochlorite Enema for Mechanical Preparation Before Elective Open Colonic or Rectal Resection With Primary Anastomosis: A Multicenter Randomized Controlled Trial
Valverde et al.
Arch Surg 2006;141:1168-1174.
ABSTRACT | FULL TEXT  

Povidone-Iodine vs Sodium Hypochlorite Enema for Mechanical Preparation Before Elective Open Colonic or Rectal Resection With Primary Anastomosis--Invited Critique
Galandiuk
Arch Surg 2006;141:1175-1175.
FULL TEXT  

Other articles noted
Evid. Based Med. 2005;10:157-158.
FULL TEXT