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Clin Colon Rectal Surg 2003; 16(2): 119-130
DOI: 10.1055/s-2003-40590
DOI: 10.1055/s-2003-40590
Bowel Preparation for Elective Colon and Rectal Surgery
Joshua A. Katz, Bruce A. Orkin- Division of Colon and Rectal Surgery, The George Washington University, Washington, District of Columbia
Further Information
Publication History
Publication Date:
18 July 2003 (online)
ABSTRACT
Bowel preparation is an integral component of elective colorectal surgery. However, minimal data exist to support this practice. Evidence favoring and opposing bowel preparation is presented and reviewed. The role of oral and antibiotic therapy is similarly examined. Finally, the evolution of bowel preparation and modern methods of preparation are discussed.
KEYWORDS
Mechanical bowel preparation - antibiotic therapy - polyethylene glycol - sodium phosphate - anastomotic leakage - wound infection
REFERENCES
- 1 Arnspiger R C, Helling T S. An evaluation of results of colon anastomosis in prepared and unprepared bowel. J Clin Gastroenterol . 1988; 10 638-641
- 2 Nichols R L, Condon R E. Preoperative preparation of the colon. Surg Gynecol Obstet . 1971; 132 323-337
- 3 Rolandelli R, Roslyn J J. Intestinal antisepsis. In: Sabiston DC, ed. Textbook of Surgery Philadelphia, PA: W.B. Saunders 1997: 979-982
- 4 Hyder J W. Preoperative bowel preparation. In: Cameron JL, ed. Current Surgical Therapy Philadelphia, PA: Mosby 1998: 261-263
- 5 Solla J A, Rothenberger D A. Preoperative bowel preparation. A survey of colon and rectal surgeons. Dis Colon Rectum . 1990; 33 154-159
- 6 Nichols R L, Smith J W, Garcia R Y. et al . Current practices of preoperative bowel preparation among North American colorectal surgeons. Clin Infect Dis . 1997; 24 609-619
- 7 Vernava A M, Stratton M D. Preoperative and postoperative management. In: Beck DE, Wexner SD, eds. Fundamentals of Anorectal Surgery Philadelphia, PA: W.B. Saunders 1998: 70-78
- 8 Stone H H, Fabian T C. Management of perforating colon trauma: randomization between primary closure and exteriorization. Ann Surg . 1979; 190 430-436
- 9 Chappuis C W, Frey D J, Dietzen C D. et al . Management of penetrating colon injuries. A prospective randomized trial. Ann Surg . 1991; 213 492-498
- 10 Sasaki L S, Allaben R D, Golwala R, Mittal V K. Primary repair of colon injuries: a prospective randomized study. J Trauma . 1995; 39 895-901
- 11 Gonzalez R P, Merlotti G J, Holevar M R. Colostomy in penetrating colon injury: is it necessary?. J Trauma Injury Infection Critical Care . 1996; 41 271-275
- 12 Demetriades D, Murray J A, Chan L. et al . Penetrating colon injuries requiring resection: diversion or primary anastomosis?. <~>An AAST prospective multicenter study. J Trauma Injury Infection Critical Care . 2001; 50 765-775
- 13 Deen K I, Madoff R D, Goldberg S M, Rothenberger D A. Surgical management of left colon obstruction: the University of Minnesota experience. J Am Coll Surg . 1998; 187 573-576
- 14 Naraynsingh V, Rampaul R, Maharaj D. et al . Prospective study of primary anastomosis without colonic lavage for patients with an obstructed left colon. Br J Surg . 1999; 86 1341-1343
- 15 Nyam D N K C, Seow-Choen F, Leong A P K F, Ho Y H. Short note: colonic decompression without on-table lavage irrigation for obstructing left sided colorectal tumors. Br J Surg . 1996; 83 786-787
- 16 Poon R TP, Law W L, Chu K W, Wong J. Emergency resection and primary anastomosis for left sided obstructing colorectal carcinoma in the elderly. Br J Surg . 1998; 85 1539-1542
- 17 Lee Y M, Law W L, Chu K W, Poon R TP. Emergency surgery for obstructing colorectal cancers: a comparison between right and left sided lesions. J Am Coll Surg . 2001; 192 719-725
- 18 Anonymous. Single-stage treatment for malignant left sided colonic obstruction: a prospective randomized clinical trial comparing subtotal colectomy with segmental resection following intraoperative irrigation. The SCOTIA Study Group. Br J Surg . 1995; 82 1622-1627
- 19 Irvin T T, Goligher J C. Aetiology of disruption of intestinal anastomoses. Br J Surg . 1973; 60 461-464
- 20 Goligher J C, Graham N G, Dedombal F T. Anastomotic dehiscence after anterior resection of rectum and sigmoid. Br J Surg . 1970; 57 109-118
- 21 Barker K, Graham N G, Mason M C. et al . The relative significance of preoperative oral antibiotics, mechanical bowel preparation, and preoperative peritoneal contamination in the avoidance of sepsis after radical surgery for ulcerative colitis and Crohn's disease of the large bowel. Br J Surg . 1971; 58 270-273
- 22 Rosenberg I L, Graham N G, Dedombal F T, Goligher J C. Preparation of the intestine in patients undergoing major large bowel surgery, mainly for neoplasms of the colon and rectum. Br J Surg . 1971; 58 266-269
- 23 Hughes E SR. Asepsis in large bowel surgery. Ann R Coll Surg Engl . 1972; 51 347-356
- 24 Irving A D, Scrimgeour D. Mechanical bowel preparation for colonic resection and anastomosis. Br J Surg . 1987; 74 580-581
- 25 Duthie G S, Foster M E, Price-Thomas J M, Leaper D J. Bowel preparation or not for elective colorectal surgery. J R Coll Surg Edinb . 1990; 35 169-171
- 26 Memon M A, Devine J, Freeney J, From S G. Is mechanical bowel preparation really necessary for elective left sided colon and rectal surgery. Int J Colorectal Dis . 1997; 12 298-302
- 26a Irvin T T, Bostock T. The effects of mechanical preparation and acidification of the colon on the healing of colonic anasthemoses. Surg Gyn Obs . 1976; 143 443-447
- 27 van Geldere D, Fa-Si-Oen P, Noach L A, Rietra P J. Complicatons after colorectal surgery without mechanical bowel preparation. J Am Coll Surg . 2002; 194 40-47
- 28 LeVeen H H, Wapnick S, Falk G. et al . Effects of prophylactic antibiotics on colonic healing. Am J Surg . 1976; 131 47-53
- 29 Smith S RG, Connolly J C, Gilmore O JA. The effect of faecal loading on colonic anastomotic healing. Br J Surg . 1983; 70 49-50
- 30 O'Dwyer P J, Conway W, McDermott E WM, O'Higgins N J. Effect of mechanical bowel preparation on anastomotic integrity following low anterior resection in dogs. Br J Surg . 1989; 76 756-758
- 31 Horgan A F, Stuart R C, O'Shaughnessay M. et al . Bacterial translocation during preoperative colonic lavage of the obstructed rat colon. Br J Surg . 1994; 81 1796-1798
- 32 Schein M, Assalia A, Eldar S, Wittman D H. Is mechanical bowel preparation necessary before primary colonic anastomosis?. <~>An experimental study. Dis Colon Rectum . 1995; 38 752-754
- 33 Brownson P, Jenkins S A, Nott D, Ellenbogen S. Mechanical bowel preparation before colorectal surgery: results of a prospective randomized trial. Br J Surg . 1992; 79 461-462
- 34 Santos J C, Batista J, Sirimarco M T. et al . Prospective randomized trial of mechanical bowel preparation in patients undergoing elective colorectal surgery. Br J Surg . 1994; 81 1673-1676
- 35 Guenaga K F. Preoperative bowel cleansing. Semin Colon Rectal Surg . 2002; 13 53-61
- 36 Burke P, Mealy K, Gillen P. et al . Requirement for bowel preparation in colorectal surgery. Br J Surg . 1994; 81 907-910
- 37 Miettinen R, Pekka J, Laitinen T S. et al . Bowel preparation with oral polyethylene glycol electrolyte solution versus no preparation in elective open colorectal surgery: prospective randomized study. Dis Colon Rectum . 2000; 43 669-677
- 38 Zmora O, Mahajna A, Barzakai B. et al . Left sided anastomosis without mechanical bowel preparation. A randomized, prospective trial. Ann Surg . 2003; 237 363-367
- 39 Baum M L, Anish D S, Chalmers T C. et al . A survey of clinical trials of antibiotic prophylaxis in colon surgery: evidence against further use of no-treatment protocols. N Engl J Med . 1981; 305 795-799
- 40 Platell C, Hall J. What is the role of mechanical bowel preparation in patients undergoing colorectal surgery?. Dis Colon Rectum . 1998; 41 875-883
- 41 Bartlett J G, Condon R E, Gorbach S L. et al . VA Cooperative Study on Bowel Preparation for Elective Colorectal Operations: impact of oral antibiotic regimen on colonic flora, wound irrigation cultures and bacteriology of septic complications. Ann Surg . 1978; 188 249-254
- 42 Page C P, Bonnen J MA, Fletcher J R. et al . Antimicrobial prophylaxis for surgical wounds. Arch Surg . 1993; 128 79-88
- 43 Beck D E, Harford F J, Dipalma J. Comparison of cleansing methods in preparation for colonic surgery. Dis Colon Rectum . 1985; 28 491-495
- 44 Evans C, Pollack A V. The reduction of surgical wound infections by prophylactic parenteral cephaloridine. Br J Surg . 1973; 60 434-437
- 45 Clarke J S, Condon R E, Bartlett J G. et al . Preoperative oral antibiotics reduce septic complications of colon operations: results of a prospective double blind randomized clinical study. Ann Surg . 1977; 186 251-259
- 46 Matheson D M, Arabi Y, Baxter-Smith D. et al . Randomized multicenter trial of oral bowel preparation and antimicrobials for elective colorectal operations. Br J Surg . 1978; 65 597-600
- 47 Condon R E, Bartlett J G, Nichols R L. et al . Preoperative prophylactic cephalothin fails to control septic complications of colorectal operations: results of a controlled clinical trial. A Veterans Administration cooperative study. Am J Surg . 1979; 137 68-74
- 48 Coppa G F, Eng K E. Factors involved in antibiotic selection in elective colon and rectal surgery. Surgery . 1988; 104 853-858
- 49 Schoetz D J, Roberts P L, Murray J J. et al . Addition of parenteral cefoxitin to regimen of oral antibiotics for elective oral colorectal operations. A randomized prospective study. Ann Surg . 1990; 212 209-212
- 50 Mitchell N J, Evans D S, Pollock D. Preoperation single dose cefuroxime antimicrobial prophylaxis with and without metronidazole. J Antimicrob Chemother . 1980; 6 393-399
- 51 Figueras-Felip J, Basilio-Bonet E, Lara-Eisman F, Caride-Garcia P. Oral is superior to systemic antibiotic prophylaxis in operations upon the colon and rectum. Surge Gynecol Obstet . 1984; 158 359-362
- 52 Lau W Y, Chu K W, Poon G P, Ho K K. Prophylactic antibiotics in elective colorectal surgery. Br J Surg . 1988; 75 782-785
- 53 Beggs F D, Jokanpatra R S, Holmes J T. A comparison of intravenous and oral metronidazole as prophylactic in colorectal surgery. Br J Surg . 1982; 69 226-227
- 54 Schwarz M, Isenman R, Thomsen J. et al . Efficacy of oral ofloxacin for single-dose perioperative prophylaxis in general: a controlled randomized clinical study. Langenbecks Arch Surg . 2001; 386 397-401
- 55 Stone H H, Hooper C A, Kolb L D. et al . Antibiotic prophylaxis in gastric, biliary, and colonic surgery. Ann Surg . 1976; 184 443-452
- 56 Stone H H, Haney B B, Kolb L D. et al . Prophylactic and preventive antibiotic therapy. Ann Surg . 1979; 691-699
- 57 Galandiuk S, Polk H C, Jagelman D G, Fazio V W. Reemphasis of priorities in surgical antimicrobial prophylaxis. Surg Gynecol Obstet . 1989; 169 219-222
- 58 Jensen L S, Andersen A, Fristrup S C. et al . Comparison of one dose versus three doses of prophylactic antibiotics, and the influence of blood transfusion on infectious complications in acute and elective colorectal surgery. Br J Surg . 1990; 77 513-518
- 59 Classen D C, Evans R S, Pestotnik S L. et al . The timing of prophylactic administration of antibiotics and the risk of surgical wound infection. N Engl J Med . 1992; 326 281-286
- 60 Goligher J C, Graham N G, Dedombal F T. Anastomotic dehiscence after anterior resection of rectum and sigmoid. Br J Surg . 1970; 57 109-118
- 61 Crapp A R, Tillotson P, Powis S JA. et al . Preparation of the bowel by whole-gut irrigation. Lancet . 1975; 2(7943) 1239-1240
- 62 Davis G R, Santa Ana A C, Morawski S G, Fortran J S. Development of a lavage solution associated with minimum water and electrolyte absorption or secretion. Gastroenterology . 1980; 78 991-995
- 63 Bowden T A, Dipiro J T, Michael K A. Polyethylene glycol electrolyte lavage solution (PEG-ELS). A rapid safe mechanical bowel preparation for colorectal surgery. Ann Surg . 1987; 53 34-36
- 64 Fleites R A, Marshall J B, Eckhauser M L. et al . The efficacy of polyethylene glycol-electrolyte lavage solution versus traditional mechanical bowel preparation for elective colonic surgery; a randomized prospective blinded, clinical trial. Surgery . 1985; 4 708-717
- 65 Beck D E, Fazio V W, Jagelman D G. Comparison of oral lavage methods for preoperative colonic cleaning. Dis Colon Rectum . 1986; 1986 699-703
- 65a Oliveira L, Weaver S D, Daniel N. et al . Mechanical bowel preparation for elective colorectal surgery. Dis Colon Rectum . 1997; 40 585-591
- 66 Lee E, Roberts P L, Taranto R. et al . Inpatient versus outpatient bowel preparation for elective colorectal surgery. Dis Colon Rectum . 1996; 39 369-373
- 67 Cohen S M, Wexner S D, Binderow S R. et al . Prospective, randomized endoscopic blinded trial comparing precolonoscopy bowel cleansing methods. Dis Colon Rectum . 1994; 37 689-696
- 68 Thomson A, Naidoo P, Crotty B. Bowel preparation for colonoscopy: a randomized prospective trial comparing sodium phosphate and polyethylene glycol in a predominantly elderly population. J Gastroenterol Hepatol . 1996; 11 103-107
- 69 Henderson J M, Barnett J L, Turgeon D K. et al . Single day, divided dose oral sodium phosphate laxative versus intestinal lavage as preparation for colonoscopy: efficacy and patient tolerance. Gastrointest Endosc . 1995; 42 635-636
- 70 Aronchick C A, Lipshutz W H, Wright S H. et al . A novel tableted purgative for colonoscopic preparation: efficacy and safety comparisons with Colyte and Fleet Phosphosoda. Gastrointest Endosc . 2000; 52 346-352
- 71 Kastenberg D, Chasen R, Choudhary C. et al . Efficacy and safety of sodium phosphate tablets compared with PEG solution in colon cleansing: two identically designed, randomized, controlled, parallel group, multicenter. Gastrointest Endosc . 2001; 54 705-713
- 72 Rex D K, Chasen R, Pochapin M B. Safety and efficacy of two reduced dosing regimens of sodium phosphate tablets for preparation prior to colonoscopy. Aliment Pharmacol Ther . 2002; 16 937-944
- 73 Vukasin P, Weston L, Beart R W. Oral Fleet Phosphosoda laxative induced hyperphosphatemia and hypocalcemic tetany in an adult: report of a case. Dis Colon Rectum . 1997; 40 497-499
- 74 Campisi P, Badhwar V, Morin S, Trudel J L. Postoperative hypocalcemic tetany caused by Fleet Phosphosoda preparation in a patient taking alendronate sodium: report of a case. Dis Colon Rectum . 1999; 42 1499-1501
- 75 Mackey A C, Shaffer D, Prizant R. Seizure associated with the use of Visicol for colonoscopy. N Engl J Med . 2002; 346 2095
- 76 Rose M, Jacob L S. Seizure associated with use of Visicol for colonoscopy. N Engl J Med . 2002; 347 295-296
- 77 Schroppel B, Segerer S, Keuneke C. et al . Hyponatremic encephalopathy after preparation for colonoscopy. Gastrointest Endosc . 2001; 43 527-529