Study on the Necessary of Mechanical Bowel Preparation before Large Bowel Surgery_Chinese Journal of Evidence-Based Medicine

Authors：

LAI Weijing ¹ , WANG Xiaodong ² ,  LI Li ²

Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

LI Li, Email: yylaiweijing@163.com

Keywords：

Mechanical bowel preparation; Selective colorectal surgery; Preoperative preparation; Evidence

DOI：

10.7507/1672-2531.20090180

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective 　We searched and reviewed medical evidence to find the guide of bowel preparation we should choose before large bowel preparation.
Method 　Firstly, we put forward clinical questions. Secondly, we searched medical evidence from PubMed, MEDLINE, EMbase, Cochrane Library, Science and ACP in recent 10 years. And then we reviewed the results.
Results 　We finally identified 17 literatures including 2 system reviews, 6 meta-analyses and 9 randomized control trials which included 4 multicentre randomized clinical trials. Most of literature suggested that there was no evidence showing the benefit of mechanical bowel preparation (MBP). No MBP before large bowel surgery would not increase rate of anastomotic leakage. On the contrary, MBP may increase the percentage of anastomotic leakage and wound infection. Considering the research with the clinical situation, we produced a new method of simplified MBP to treat the patient. It reached the predictive effect.
Conclusion 　No evidence of systematic review and meta-analysis supports the benefit of BMP. The new simplified bowel preparation before surgery in West China Hospital was worthy to test.

Citation： LAI Weijing,WANG Xiaodong,LI Li. Study on the Necessary of Mechanical Bowel Preparation before Large Bowel Surgery. Chinese Journal of Evidence-Based Medicine, 2009, 09(9): 1022-1025. doi: 10.7507/1672-2531.20090180 Copy

1.	van Geldere D, Fa-Si-Oen P, Noach LA, et al. Complications after Colorectal Surgery Without Mechanical Bowel Preparation. J Am Coll Surg, 2002, 194(1): 40-47.
2.	Horgan AF, Stuart RC, O’Shaughnessy EM, et al. Bacterial translocation during peroperative colonic lavage of the obstructed rat colon [see comments]. Br J Surg, 1994, 81: 1796-1798.
3.	Kale TI, Kuzu MA, Tekeli A, et al. Aggressive bowel preparation does not enhance bacterial translocation, provided the mucosal barrier is not disrupted: a prospective, randomized study. Dis Colon Rectum, 1998, 41: 636-641.
4.	Keighley MR. A clinical and physiological evaluation of bowel preparation for elective colorectal surgery. World J Surg, 1982, 6: 464-470.
5.	Ambrose NS, Keighley MR. Physiological consequences of orthograde lavage bowel preparation for elective colorectal surgery: a review. J R Soc Med, 1983, 76(9): 767-771.
6.	Irving AD, Scrimgeour D. Mechanical bowel preparation for colonic resection and anastomosis. Br J Surg, 1987, 74(7): 580-581.
7.	梁伟雄, 张彤, 洪云, 等. 管饲全肠内营养在大肠癌术前应用的临床研究. 中国实用外科杂志, 2005, 25(12): 737-738.
8.	Granberry MC, White LM, Gardner SF. Exacerbation of congestive heart failure failure after administration of polyethylene glycolelectrolyte lavage solution. Ann Phar, 1995, 29(12): 1232-1235.
9.	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[Abstract]. Dis Colon Rectum, 2005, 48(8): 1509-1516.
10.	Ram E, Sherman Y, Weil R, et al. Is mechanical bowel preparation mandatory for elective colon surgery, a prospective randomized study? Arch Surg, 2005, 140: 285-288.
11.	Zmora O, Bar-Zakai B, Shabtai M, et al. Is mechanical bowel preparation mandatory for left-sided colonic anastomosis? Results of a prospective randomized trial. Tech Coloproctol, 2006, 10: 131-135.
12.	Zmora O, Mahajna A, Bar-Zakai B, et al. Colon and rectal surgery without mechanical bowel preparation: a randomized prospective trial. Ann Surg, 2003: 363-367.
13.	Contant CME, Hop WCJ, Pieter van’t Sant H, et al. Mechanical bowel preparation for elective colorectal surgery: a multicentre randomised trial. Lancet, 2007, 370: 2112-2117.
14.	Jung B, Pahlman L, Nystro¨m PO, et al. Multicentre randomized clinical trial of mechanical bowel preparation in elective colonic resection. Br J Surgery, 2007, 94: 689-695.
15.	Bucher P, Gervaz P, Soravia C, et al. Randomized clinical trial of mechanical bowel preparation versus no preparation before elective left-sided colorectal surgery. Br J Surg, 2005, 92: 409-414.
16.	Miettinen RPJ, Laitinen ST, Makela JT, et al. Bowel preparation with oral polyethylene glycol electrolyte solution vs. no preparation in elective open colorectal surgery. Dis Colon Rectum, 2000, 43: 669-677.
17.	Wille-Jørgensen P, Guenaga KF, A. Castro A, et al. Clinical value of preoperative mechanical bowel cleansing in elective colorectal surgery: a systematic review. Dis Colon Rectum, 2003, 46: 1013-1020.
18.	Bucher P, Mermillod B, Gervaz P, et al. Mechanical Bowel Preparation for Elective Colorectal Surgery, A meta-analysis. Arch Surg, 2004, 139: 1359-1364.
19.	Guenaga K, Atallah AN, Castro AA, et al. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD001544. DOI: 10.1002/14651858.CD001544.pub2.
20.	Gravante G, Caruso R, Andreani SM, et al. Mechanical bowel preparation for colorectal surgery:a meta-analysis on abdominal and systemic complications on almost 5,000 patients. Int J Colorectal Dis, 2008, 23: 1145-1150.
21.	Pineda CE, Shelton AA, Hernandez-Boussard T, et al. Mechanical bowel preparation in intestinal surgery: a meta-analysis and review of the literature. J Gastrointest Surg, 2008, 12(11): 2037-2044.
22.	Bucher P, Gervaz P, Egger JF, et al. Morphologic alterations associated with mechanical bowel preparation before elective colorectal surgery: a randomized trial. Dis Colon Rectum, 2005, 49: 109-112.
23.	Slim K, Vicaut E, Panis Y, et al. Meta-analysis of randomized clinical trials of colorectal surgery with or without mechanical bowel preparation. Br J Surg, 2004, 91: 1125-1130.
24.	Bucher P, Mermillod B, Morel P, et al. Does mechanical bowel preparation have a role in preventing postoperative complications in elective colorectal surgery? A meta-analysis. Swiss Med Wkly, 2004, 134: 69-74.
25.	Wille-Jørgensen p, Guenaga KF, Matos D, et al. Pre-operative mechanical bowel cleansing or not? an updated meta-analysis. Colorectal Dis, 2005, 7(4): 304-310.

1. van Geldere D, Fa-Si-Oen P, Noach LA, et al. Complications after Colorectal Surgery Without Mechanical Bowel Preparation. J Am Coll Surg, 2002, 194(1): 40-47.
2. Horgan AF, Stuart RC, O’Shaughnessy EM, et al. Bacterial translocation during peroperative colonic lavage of the obstructed rat colon [see comments]. Br J Surg, 1994, 81: 1796-1798.
3. Kale TI, Kuzu MA, Tekeli A, et al. Aggressive bowel preparation does not enhance bacterial translocation, provided the mucosal barrier is not disrupted: a prospective, randomized study. Dis Colon Rectum, 1998, 41: 636-641.
4. Keighley MR. A clinical and physiological evaluation of bowel preparation for elective colorectal surgery. World J Surg, 1982, 6: 464-470.
5. Ambrose NS, Keighley MR. Physiological consequences of orthograde lavage bowel preparation for elective colorectal surgery: a review. J R Soc Med, 1983, 76(9): 767-771.
6. Irving AD, Scrimgeour D. Mechanical bowel preparation for colonic resection and anastomosis. Br J Surg, 1987, 74(7): 580-581.
7. 梁伟雄, 张彤, 洪云, 等. 管饲全肠内营养在大肠癌术前应用的临床研究. 中国实用外科杂志, 2005, 25(12): 737-738.
8. Granberry MC, White LM, Gardner SF. Exacerbation of congestive heart failure failure after administration of polyethylene glycolelectrolyte lavage solution. Ann Phar, 1995, 29(12): 1232-1235.
9. 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[Abstract]. Dis Colon Rectum, 2005, 48(8): 1509-1516.
10. Ram E, Sherman Y, Weil R, et al. Is mechanical bowel preparation mandatory for elective colon surgery, a prospective randomized study? Arch Surg, 2005, 140: 285-288.
11. Zmora O, Bar-Zakai B, Shabtai M, et al. Is mechanical bowel preparation mandatory for left-sided colonic anastomosis? Results of a prospective randomized trial. Tech Coloproctol, 2006, 10: 131-135.
12. Zmora O, Mahajna A, Bar-Zakai B, et al. Colon and rectal surgery without mechanical bowel preparation: a randomized prospective trial. Ann Surg, 2003: 363-367.
13. Contant CME, Hop WCJ, Pieter van’t Sant H, et al. Mechanical bowel preparation for elective colorectal surgery: a multicentre randomised trial. Lancet, 2007, 370: 2112-2117.
14. Jung B, Pahlman L, Nystro¨m PO, et al. Multicentre randomized clinical trial of mechanical bowel preparation in elective colonic resection. Br J Surgery, 2007, 94: 689-695.
15. Bucher P, Gervaz P, Soravia C, et al. Randomized clinical trial of mechanical bowel preparation versus no preparation before elective left-sided colorectal surgery. Br J Surg, 2005, 92: 409-414.
16. Miettinen RPJ, Laitinen ST, Makela JT, et al. Bowel preparation with oral polyethylene glycol electrolyte solution vs. no preparation in elective open colorectal surgery. Dis Colon Rectum, 2000, 43: 669-677.
17. Wille-Jørgensen P, Guenaga KF, A. Castro A, et al. Clinical value of preoperative mechanical bowel cleansing in elective colorectal surgery: a systematic review. Dis Colon Rectum, 2003, 46: 1013-1020.
18. Bucher P, Mermillod B, Gervaz P, et al. Mechanical Bowel Preparation for Elective Colorectal Surgery, A meta-analysis. Arch Surg, 2004, 139: 1359-1364.
19. Guenaga K, Atallah AN, Castro AA, et al. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD001544. DOI: 10.1002/14651858.CD001544.pub2.
20. Gravante G, Caruso R, Andreani SM, et al. Mechanical bowel preparation for colorectal surgery:a meta-analysis on abdominal and systemic complications on almost 5,000 patients. Int J Colorectal Dis, 2008, 23: 1145-1150.
21. Pineda CE, Shelton AA, Hernandez-Boussard T, et al. Mechanical bowel preparation in intestinal surgery: a meta-analysis and review of the literature. J Gastrointest Surg, 2008, 12(11): 2037-2044.
22. Bucher P, Gervaz P, Egger JF, et al. Morphologic alterations associated with mechanical bowel preparation before elective colorectal surgery: a randomized trial. Dis Colon Rectum, 2005, 49: 109-112.
23. Slim K, Vicaut E, Panis Y, et al. Meta-analysis of randomized clinical trials of colorectal surgery with or without mechanical bowel preparation. Br J Surg, 2004, 91: 1125-1130.
24. Bucher P, Mermillod B, Morel P, et al. Does mechanical bowel preparation have a role in preventing postoperative complications in elective colorectal surgery? A meta-analysis. Swiss Med Wkly, 2004, 134: 69-74.
25. Wille-Jørgensen p, Guenaga KF, Matos D, et al. Pre-operative mechanical bowel cleansing or not? an updated meta-analysis. Colorectal Dis, 2005, 7(4): 304-310.

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