Meta-Analysis
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2018; 24(4): 519-536
Published online Jan 28, 2018. doi: 10.3748/wjg.v24.i4.519
Impact of mechanical bowel preparation in elective colorectal surgery: A meta-analysis
Katie E Rollins, Hannah Javanmard-Emamghissi, Dileep N Lobo
Katie E Rollins, Hannah Javanmard-Emamghissi, Dileep N Lobo, Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute of Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UH, United Kingdom
Author contributions: Rollins KE and Javanmard-Emamghissi H designed this work, collected data, and drafted the manuscript; Lobo DN conceptioned and designed this work, collected and interpreted the data, critically revised the manuscript, and overall supervision; all authors contributed to final approval, accountability for the manuscript.
Conflict-of-interest statement: None of the authors has a direct conflict of interest to declare (Lobo DN has received unrestricted research funding and speaker’s honoraria from Fresenius Kabi, BBraun and Baxter Healthcare for unrelated work).
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dileep N Lobo, MS, DM, FRCS, FACS, FRCPE, Professor of Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, Nottingham University Hospitals NHS Trust, Queen’s Medical Centre, Nottingham NG7 2UH, United Kingdom. dileep.lobo@nottingham.ac.uk
Telephone: +44-115-8231149 Fax: +44-115-8231160
Received: October 3, 2017
Peer-review started: October 5, 2017
First decision: October 18, 2017
Revised: October 25, 2017
Accepted: November 8, 2017
Article in press: November 8, 2017
Published online: January 28, 2018
Processing time: 114 Days and 9.4 Hours
Abstract
AIM

To analyse the effect of mechanical bowel preparation vs no mechanical bowel preparation on outcome in patients undergoing elective colorectal surgery.

METHODS

Meta-analysis of randomised controlled trials and observational studies comparing adult patients receiving mechanical bowel preparation with those receiving no mechanical bowel preparation, subdivided into those receiving a single rectal enema and those who received no preparation at all prior to elective colorectal surgery.

RESULTS

A total of 36 studies (23 randomised controlled trials and 13 observational studies) including 21568 patients undergoing elective colorectal surgery were included. When all studies were considered, mechanical bowel preparation was not associated with any significant difference in anastomotic leak rates (OR = 0.90, 95%CI: 0.74 to 1.10, P = 0.32), surgical site infection (OR = 0.99, 95%CI: 0.80 to 1.24, P = 0.96), intra-abdominal collection (OR = 0.86, 95%CI: 0.63 to 1.17, P = 0.34), mortality (OR = 0.85, 95%CI: 0.57 to 1.27, P = 0.43), reoperation (OR = 0.91, 95%CI: 0.75 to 1.12, P = 0.38) or hospital length of stay (overall mean difference 0.11 d, 95%CI: -0.51 to 0.73, P = 0.72), when compared with no mechanical bowel preparation, nor when evidence from just randomized controlled trials was analysed. A sub-analysis of mechanical bowel preparation vs absolutely no preparation or a single rectal enema similarly revealed no differences in clinical outcome measures.

CONCLUSION

In the most comprehensive meta-analysis of mechanical bowel preparation in elective colorectal surgery to date, this study has suggested that the use of mechanical bowel preparation does not affect the incidence of postoperative complications when compared with no preparation. Hence, mechanical bowel preparation should not be administered routinely prior to elective colorectal surgery.

Keywords: Bowel preparation; Mechanical; Antibiotics; Morbidity; Mortality; Surgery; Outcome complications; Meta-analysis

Core tip: At present there is no evidence that bowel preparation makes a difference to clinical outcomes in either colonic or rectal surgery, in terms of anastomotic leak rates, surgical site infection, intra-abdominal collection, mortality, reoperation or hospital length of stay. Given its potential adverse effects and patient dissatisfaction rates, it should not be administered routinely to patients undergoing elective colorectal surgery.