MECHANICAL BOWEL PREPARATION FOR ELECTIVE COLORECTAL SURGERY - A PROSPECTIVE, RANDOMIZED, SURGEON-BLINDED TRIAL COMPARING SODIUM-PHOSPHATE AND POLYETHYLENE GLYCOL-BASED ORAL LAVAGE SOLUTIONS

AIM: The aim of this study was to compare the cleansing ability, patie nt compliance, and safety of two oral solutions for elective colorecta l surgery. METHODS: All eligible patients were prospectively randomize d to receive either 4 l of standard polyethylene glycol (PEG) solution or 90 ml of sodium phosphate (NaP) as mechanical bowel preparation fo r colorectal surgery. A detailed questionnaire was used to assess pati ent compliance. In addition, the surgeons, blinded to the preparation, intraoperatively evaluated its quality. Postoperative septic complica tions were also assessed. The calcium serum level was monitored before and after bowel preparation. Statistical analysis was performed using the Wilcoxon's rank-sum test and Fisher's exact test. RESULTS: Two hu ndred patients, well matched for age, gender, and diagnosis, were pros pectively randomized to receive either PEG or NaP solutions for electi ve colorectal surgery. All patients completed all phases of the trial. There was a significant decrease in serum calcium levels after admini stration of both NaP (mean, 9.3-8.8 mg/dl) and PEG (9.2-8.9 mg/dl), re spectively (P < 0.0001), with no clinical sequelae. However, patient t olerance to NaP was superior to PEG: less trouble drinking the prepara tion (17 vs. 32 percent; P < 0.0002), less abdominal pain (12 vs. 22 p ercent; P = 0.004), less bloating Ci vs. 28 percent), and less fatigue (8 vs. 17 percent), respectively. Additionally, 65 percent of patient s who received the NaP preparation stated they would repeat this prepa ration again compared with only 25 percent for the PEG group (P < 0.00 01). Ninety-five percent of patients who received the NaP solution tol erated 100 percent of the solution compared with only 37 percent of th e PEG group (P < 0.0001). For quality of cleansing, surgeons scored Na P as ''excellent'' or ''good'' in 87 compared with 76 percent after PE G (P = not significant). Rates of septic and anastomotic complications were 1 percent and 1 percent for NaP and 4 percent and 1 percent for PEG, respectively (P = not significant). CONCLUSION: Both oral solutio ns proved to be equally effective and safe. However, patient tolerance of the small volume of NaP demonstrated a clear advantage over the tr aditional PEG solution.