Bowel preparation for colorectal surgery

PURPOSE: The aim of this study was to assess recent literature regarding bo wel preparation for colonoscopy and surgery. METHODS: The study was conduct ed by an Index Medicus English-language search of articles relevant to both oral mechanical and parenteral and oral antibiotic preparation for electiv e colorectal surgery and mechanical bowel preparation for colonoscopy. The study period was from 1975 to 2000. In addition, studies of elective colore ctal surgery without mechanical bowel preparation were also considered. RES ULTS: Although several recent prospective, randomized trials have suggested that elective colorectal surgery can be safely performed without any mecha nical bowel preparation, mechanical bowel preparation remains the standard of care, at least in North America at the present time. A recent survey of the members of The American Society of Colon and Rectal Surgeons revealed t hat the majority currently use sodium phosphate for bowel preparation and u se a dual oral antibiotic regimen before elective colorectal surgery, combi ned with two doses of parenteral antibiotics. Although some of the use patt erns are based on prospective, randomized study, others seem founded strict ly on habit and theory. CONCLUSIONS: The current methods of bowel cleansing for both colonoscopy and surgery include sodium phosphate and polyethylene glycol; colorectal surgeons practicing in North America currently prefer s odium phosphate. Additional preparation for colorectal surgery includes per ioperative parenteral antibiotics and, to a slightly lesser degree, preoper ative oral antibiotic preparation. Although some recent prospective, random ized studies have suggested that omission of mechanical bowel preparation f or elective colorectal. surgery is not only feasible but potentially prefer able, caution is recommended before routinely omitting these widely practic ed measures, because data to support such routine omission are limited.