This week we want to share how to prepare the bowel for elective colorectal surgery.

Objectives: To assess the evidence for the use of combined mechanical and oral antibiotic bowel preparation for preventing complications in elective colorectal surgery.

Main results: 21 randomized studies, analysing 5264 participants who underwent elective colorectal surgery.

Mechanical bowel preparation (MBP) plus oral antibiotics (oAB) versus MBP:

• The incidence of surgical site infections could be reduced through MBP+oAB by 44%, moderate‐certainty evidence.
• The risk of anastomotic leakage could be reduced by 40%, moderate‐certainty evidence.
• No difference between the two groups was found with regard to mortality.

MBP + oAB versus sole oAB:

• No difference in surgical site infections, very low-certainty evidence.
• No difference in anastomotic leakage, very low-certainty evidence.
• No difference in mortality, very low-certainty evidence.

The authors conclude that based on moderate‐certainty evidence, the results suggest that mechanical bowel preparation plus oral antibiotics are probably more effective than mechanical bowel preparation alone in preventing postoperative complications. A lower incidence of surgical site infections and anastomotic leakage was demonstrated for mechanical bowel preparation plus oral antibiotics.

It remains unclear whether omitting preoperative bowel preparation leads to an increase in the risk of postoperative complications due to limited evidence.

Access the publication here: https://doi.org/10.1002/14651858.CD014909.pub2