Bowel Preparation before Elective Colorectal Surgery: Its Current Role

Bowel preparation for elective colorectal surgery has been performed for decades with the assumption to decrease infectious complications and anastomotic leaks. Nevertheless, the scientific basis of the same is still debatable. Various methods of bowel preparation are mechanical bowel preparation (MBP) with or without prophylactic oral antibiotics (POA), preoperative POA alone without MBP, and preoperative enema alone without MBP and POA. However, there is no consensus on the optimal type of bowel preparation. The available agents for MBP are polyethylene glycol (PEG) and sodium phosphate (NaP) or picosulphate. The most common prophylactic oral antibiotic regimen used in preoperative bowel preparation is Neomycin and Metronidazole a day before surgery, although the microbiological basis of this is unverified. Most studies around the beginning of this century indicate inadequate evidence for using MBP for colorectal surgery to suggest harm caused by the process and accordingly advise against it. However, several retrospective studies and meta-analyses, which were done after 2014, arguably demonstrate that preoperative MBP and POA reduce the postoperative surgical site infection rate. However, as per the current evidence, it can be suggested that MBP and preoperative POA can be safely included in the preoperative preparation of elective colorectal surgery.