Research news from The Cochrane Library 20 October 2003: Surgeons and other experts have long regarded mechanical bowel preparation to be an essential preventative measure before colorectal surgery. Recent evidence in The Cochrane Library, however, reveals that mechanical bowel cleansing does not significantly decrease the risk of anastomic leakage or other complications.

Researchers reviewed six studies performed over the last thirty years into the relationship between mechanical bowel cleansing and associated patient morbidity and mortality. Most surgeons require this cleansing of their patients prior to operating, believing the risks of infection, anastomic leakage and other complications to be significantly reduced.

The conclusion reached will be inevitably surprising to professionals who have subscribed to this dogma for years: bowel preparation was not found to have any significant positive effect upon morbidity or mortality of patients undergoing elective colorectal surgery. The process of bowel cleansing is known to be gruelling and carries risks in its own right.

Gastric intolerance, low serum potassium levels, electrolyte disturbance and bowel explosion are all risks associated with the bowel cleansing process. The result indicates a higher risk of anastomotic leakage when cleansing is used.

"The hypothesis that faecal matter in the bowel led to complications after surgery stood for over a century before we arrived at this conclusion to the contrary," says co-author of the study Dr Peer Wille-Jørgensen.

Notes

Guenaga KF, Matos D, Castro AA, Atallah AN, Wille-Jørgensen P. Mechanical bowel preparation for elective colorectal surgery (Cochrane Review). In: The Cochrane Library, Issue 3, 2003.