Mechanical Bowel Preparation for Elective Colorectal Surgery: Updated Systematic Review and Meta-Analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 FANGYu , CAOFeng ,  LIFei

Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China;

Corresponding author：

LIFei, Email: feili36@ccmu.edu.cn

Keywords：

Mechanical bowel preparation; Colorectal surgery; Meta-analysis

DOI：

10.7507/1007-9424.20140304

Video：

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Objective To determine the benefits and harms of mechanical bowel preparation(MBP) in elective colorectal surgery. Methods Cochrane systematic evaluation was used to search through Cochrane libraries of clinical comparative trials, PubMed, Embase, Cancer Lit, and the Chinese BioMedical Literature on disc. The quality of literatures was independently evaluated and cross-checked by two evaluators, indicator for assessment including anastomotic leak, overall surgical site infection(SSI), extra-abdominal septic complications, wound infections, reoperation or second intervention rate, and death. The results were analysed with RevMan 5.1 software. Results Fourteen RCTs were included in this analysis with a total number of 5 373 patients. Comparing with no MBP for elective colorectal surgery, the study results showed that MBP had not reduce any postoperative complications when concerning anastomotic leak[OR(95% CI), 1.08(0.82-1.43);P=0.56];overall SSI[OR(95% CI), 1.26(0.94-1.68);P=0.12];extra-abdominal septic complications[OR(95% CI), 0.98(0.81-1.18);P=0.81];wound infections[OR(95% CI), 1.21(1.00-1.46);P=0.05];reoperation or second intervention rate[OR(95% CI), 1.11(0.86-1.45);P=0.42], and death[OR(95% CI), 0.97(0.63-1.48);P=0.88]. Conclusion No evidence supporting the use of MBP in patients undergoing elective colorectal surgery. MBP should be omitted in routine clinical practice.

Citation： FANGYu, CAOFeng, LIFei. Mechanical Bowel Preparation for Elective Colorectal Surgery: Updated Systematic Review and Meta-Analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(10): 1277-1283. doi: 10.7507/1007-9424.20140304 Copy

1.	Eskicioglu C, Forbes SS, Fenech DS, et al. Preoperative bowel preparation for patients undergoing elective colorectal surgery:a clinical practice guideline endorsed by the Canadian Society of Colon and Rectal Surgeons[J]. Can J Surg, 2010, 53(6):385-395.
2.	Nicholson GA, Finlay IG, Diament RH, et al. Mechanical bowel preparation does not influence outcomes following colonic cancer resection[J]. Br J Surg, 2011, 98(6):866-871.
3.	Zhu QD, Zhang QY, Zeng QQ, et al. Efficacy of mechanical bowel preparation with polyethylene glycol in prevention of postoperative complications in elective colorectal surgery:a meta-analysis[J]. Int J Colorectal Dis, 2010, 25(2):267-275.
4.	Slim K, Vicaut E, Launay-Savary MV, et al. Updated systematic review and meta-analysis of randomized clinical trials on the role of mechanical bowel preparation before colorectal surgery[J]. Ann Surg, 2009, 249(2):203-209.
5.	Scabini S, Rimini E, Romairone E, et al. Colon and rectal surgery for cancer without mechanical bowel preparation:one-center ran-domized prospective trial[J]. World J Surg Oncol, 2010, 8:35.
6.	Bretagnol F, Panis Y, Rullier E, et al. Rectal cancer surgery with or without bowel preparation:The French GRECCARⅢmulticenter single-blinded randomized trial[J]. Ann Surg, 2010, 252(5):863-868.
7.	Van't Sant HP, Weidema WF, Hop WC, et al. The influence of mechanical bowel preparation in elective lower colorectal surgery[J]. Ann Surg, 2010, 251(1):59-63.
8.	Contant CM, Hop WC, Van'T SH, et al. Mechanical bowel preparation for elective colorectal surgery:a multicentre rando-mised trial[J]. Lancet, 2007, 370(9605):2112-2117.
9.	Jung B, Pahlman L, Nystrom PO, et al. Multicentre randomized clinical trial of mechanical bowel preparation in elective colonic resection[J]. Br J Surg, 2007, 94(6):689-695.
10.	Pena-Soria MJ, Mayol JM, Anula R, et al. Single-blinded rando-mized trial of mechanical bowel preparation for colon surgery with primary intraperitoneal anastomosis[J]. J Gastrointest Surg, 2008, 12(12):2103-2109.
11.	Zmora O, Mahajna A, Bar-Zakai B, et al. Is mechanical bowel preparation mandatory for left-sided colonic anastomosis? Results of a prospective randomized trial[J]. Tech Coloproctol, 2006, 10(2):131-135.
12.	Ram E, Sherman Y, Weil R, et al. Is mechanical bowel preparation mandatory for elective colon surgery? A prospective rando-mized study[J]. Arch Surg, 2005, 140(3):285-288.
13.	Fa-Si-Oen P, Roumen R, Buitenweg J, et al. Mechanical bowel preparation or not? Outcome of a multicenter, randomized trial in elective open colon surgery[J]. Dis Colon Rectum, 2005, 48(8):1509-1516.
14.	Bucher P, Gervaz P, Soravia C, et al. Randomized clinical trial of mechanical bowel preparation versus no preparation before elective left-sided colorectal surgery[J]. Br J Surg, 2005, 92(4):409-414.
15.	Zmora O, Mahajna A, Bar-Zakai B, et al. Colon and rectal surgery without mechanical bowel preparation:a randomized prospective trial[J]. Ann Surg, 2003, 237(3):363-367.
16.	Miettinen RP, Laitinen ST, Makela JT, et al. Bowel preparation with oral polyethylene glycol electrolyte solution vs. no preparation in elective open colorectal surgery:prospective, randomized study[J]. Dis Colon Rectum, 2000, 43(5):669-675.
17.	Santos JJ, Batista J, Sirimarco MT, et al. Prospective randomized trial of mechanical bowel preparation in patients undergoing elective colorectal surgery[J]. Br J Surg, 1994, 81(11):1673-1676.
18.	Burke P, Mealy K, Gillen P, et al. Requirement for bowel preparation in colorectal surgery[J]. Br J Surg, 1994, 81(6):907-910.
19.	Brownson P, Jenkins SA, Nott D, et al. Mechanical bowel preparation before colorectal surgery:results of a prospective rando-mized trial[J]. Br J Surg, 1992, 79(5):461-462.
20.	Drummond RJ, McKenna RM, Wright DM. Current practice in bowel preparation for colorectal surgery:a survey of the members of the Association of Coloproctology of GB & Ireland[J]. Colorectal Dis, 2011, 13(6):708-710.
21.	Hasenberg T, Langle F, Reibenwein B, et al. Current perioperative practice in rectal surgery in Austria and Germany[J]. Int J Colorectal Dis, 2010, 25(7):855-863.
22.	Oliveira L, Wexner SD, Daniel N, et al. Mechanical bowel preparation for elective colorectal surgery. A prospective, rando-mized, surgeon-blinded trial comparing sodium phosphate and polyethylene glycol-based oral lavage solutions[J]. Dis Colon Rectum, 1997, 40(5):585-591.
23.	Bretagnol F, Alves A, Ricci A, et al. Rectal cancer surgery without mechanical bowel preparation[J]. Br J Surg, 2007, 94(10):1266-1271.
24.	Vlot EA, Zeebregts CJ, Gerritsen JJ, et al. Anterior resection of rectal cancer without bowel preparation and diverting stoma[J]. Surg Today, 2005, 35(8):629-633.
25.	Zmora O, Lebedyev A, Hoffman A, et al. Laparoscopic colectomy without mechanical bowel preparation[J]. Int J Colorectal Dis, 2006, 21(7):683-687.

1. Eskicioglu C, Forbes SS, Fenech DS, et al. Preoperative bowel preparation for patients undergoing elective colorectal surgery:a clinical practice guideline endorsed by the Canadian Society of Colon and Rectal Surgeons[J]. Can J Surg, 2010, 53(6):385-395.
2. Nicholson GA, Finlay IG, Diament RH, et al. Mechanical bowel preparation does not influence outcomes following colonic cancer resection[J]. Br J Surg, 2011, 98(6):866-871.
3. Zhu QD, Zhang QY, Zeng QQ, et al. Efficacy of mechanical bowel preparation with polyethylene glycol in prevention of postoperative complications in elective colorectal surgery:a meta-analysis[J]. Int J Colorectal Dis, 2010, 25(2):267-275.
4. Slim K, Vicaut E, Launay-Savary MV, et al. Updated systematic review and meta-analysis of randomized clinical trials on the role of mechanical bowel preparation before colorectal surgery[J]. Ann Surg, 2009, 249(2):203-209.
5. Scabini S, Rimini E, Romairone E, et al. Colon and rectal surgery for cancer without mechanical bowel preparation:one-center ran-domized prospective trial[J]. World J Surg Oncol, 2010, 8:35.
6. Bretagnol F, Panis Y, Rullier E, et al. Rectal cancer surgery with or without bowel preparation:The French GRECCARⅢmulticenter single-blinded randomized trial[J]. Ann Surg, 2010, 252(5):863-868.
7. Van't Sant HP, Weidema WF, Hop WC, et al. The influence of mechanical bowel preparation in elective lower colorectal surgery[J]. Ann Surg, 2010, 251(1):59-63.
8. Contant CM, Hop WC, Van'T SH, et al. Mechanical bowel preparation for elective colorectal surgery:a multicentre rando-mised trial[J]. Lancet, 2007, 370(9605):2112-2117.
9. Jung B, Pahlman L, Nystrom PO, et al. Multicentre randomized clinical trial of mechanical bowel preparation in elective colonic resection[J]. Br J Surg, 2007, 94(6):689-695.
10. Pena-Soria MJ, Mayol JM, Anula R, et al. Single-blinded rando-mized trial of mechanical bowel preparation for colon surgery with primary intraperitoneal anastomosis[J]. J Gastrointest Surg, 2008, 12(12):2103-2109.
11. Zmora O, Mahajna A, Bar-Zakai B, et al. Is mechanical bowel preparation mandatory for left-sided colonic anastomosis? Results of a prospective randomized trial[J]. Tech Coloproctol, 2006, 10(2):131-135.
12. Ram E, Sherman Y, Weil R, et al. Is mechanical bowel preparation mandatory for elective colon surgery? A prospective rando-mized study[J]. Arch Surg, 2005, 140(3):285-288.
13. Fa-Si-Oen P, Roumen R, Buitenweg J, et al. Mechanical bowel preparation or not? Outcome of a multicenter, randomized trial in elective open colon surgery[J]. Dis Colon Rectum, 2005, 48(8):1509-1516.
14. Bucher P, Gervaz P, Soravia C, et al. Randomized clinical trial of mechanical bowel preparation versus no preparation before elective left-sided colorectal surgery[J]. Br J Surg, 2005, 92(4):409-414.
15. Zmora O, Mahajna A, Bar-Zakai B, et al. Colon and rectal surgery without mechanical bowel preparation:a randomized prospective trial[J]. Ann Surg, 2003, 237(3):363-367.
16. Miettinen RP, Laitinen ST, Makela JT, et al. Bowel preparation with oral polyethylene glycol electrolyte solution vs. no preparation in elective open colorectal surgery:prospective, randomized study[J]. Dis Colon Rectum, 2000, 43(5):669-675.
17. Santos JJ, Batista J, Sirimarco MT, et al. Prospective randomized trial of mechanical bowel preparation in patients undergoing elective colorectal surgery[J]. Br J Surg, 1994, 81(11):1673-1676.
18. Burke P, Mealy K, Gillen P, et al. Requirement for bowel preparation in colorectal surgery[J]. Br J Surg, 1994, 81(6):907-910.
19. Brownson P, Jenkins SA, Nott D, et al. Mechanical bowel preparation before colorectal surgery:results of a prospective rando-mized trial[J]. Br J Surg, 1992, 79(5):461-462.
20. Drummond RJ, McKenna RM, Wright DM. Current practice in bowel preparation for colorectal surgery:a survey of the members of the Association of Coloproctology of GB & Ireland[J]. Colorectal Dis, 2011, 13(6):708-710.
21. Hasenberg T, Langle F, Reibenwein B, et al. Current perioperative practice in rectal surgery in Austria and Germany[J]. Int J Colorectal Dis, 2010, 25(7):855-863.
22. Oliveira L, Wexner SD, Daniel N, et al. Mechanical bowel preparation for elective colorectal surgery. A prospective, rando-mized, surgeon-blinded trial comparing sodium phosphate and polyethylene glycol-based oral lavage solutions[J]. Dis Colon Rectum, 1997, 40(5):585-591.
23. Bretagnol F, Alves A, Ricci A, et al. Rectal cancer surgery without mechanical bowel preparation[J]. Br J Surg, 2007, 94(10):1266-1271.
24. Vlot EA, Zeebregts CJ, Gerritsen JJ, et al. Anterior resection of rectal cancer without bowel preparation and diverting stoma[J]. Surg Today, 2005, 35(8):629-633.
25. Zmora O, Lebedyev A, Hoffman A, et al. Laparoscopic colectomy without mechanical bowel preparation[J]. Int J Colorectal Dis, 2006, 21(7):683-687.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Mechanical Bowel Preparation for Elective Colorectal Surgery: Updated Systematic Review and Meta-Analysis

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