CURRENT PRACTICES OF PREOPERATIVE BOWEL PREPARATION AMONG NORTH-AMERICAN COLORECTAL SURGEONS

In North America, the rate of infections following colorectal surgery decreased after the introduction of oral antibiotic bowel preparation against colonic microflora. Eight hundred eight board-certified colore ctal surgeons were surveyed for their current bowel preparation practi ces before elective procedures. The 471 responders (58%) all use mecha nical preparation: oral polyethylene glycol solution (70.9% of the res pondents), oral sodium phosphate solution with or without bisacodyl (2 8.4%), and ''traditional'' methods of dietary restriction, cathartics, and enemas (28.4%). Most surgeons (86.5%) add oral and parenteral ant ibiotics to the regimen; 11.5% add only parenteral antibiotics, 1.1% a dd only oral antibiotics, and 0.9% add no antibiotics. Generally (77.8 % of cases), oral neomycin and erythromycin or metronidazole are combi ned with a perioperative parenteral antibiotic. Most individuals start the preparation as outpatients the day before surgery, and the parent eral drugs are added to the regimen 1-2 hours before the procedure. Th e use of outpatient bowel preparation is increasing; however, patient selection is critical, and education is needed to reduce the rate of c omplications.