From the Guidelines
Bowel preparation for a hepatectomy should not include routine mechanical bowel preparation, and patients should follow the enhanced recovery after surgery (ERAS) guidelines, which recommend preoperative fasting not to exceed 6 hours for solids and 2 hours for liquids, as well as carbohydrate loading the evening before and 2 hours before induction of anesthesia 1.
Key Considerations for Bowel Prep in Hepatectomy
- The primary goal of bowel preparation in the context of hepatectomy is to minimize the risk of infection and improve surgical outcomes, rather than to thoroughly cleanse the bowel as might be done for colorectal surgery.
- Recent guidelines, such as those from the Enhanced Recovery After Surgery (ERAS) Society, emphasize the importance of optimizing the patient's condition before surgery to reduce morbidity and mortality, and improving quality of life post-operatively.
- The ERAS recommendations for liver surgery, as outlined in the study published in the World Journal of Emergency Surgery in 2016 1, provide a framework for perioperative care that includes specific guidance on preoperative fasting and carbohydrate loading.
Implementation of ERAS Guidelines for Hepatectomy
- Preoperative fasting should not exceed 6 hours for solids and 2 hours for liquids, as recommended by the ERAS society 1.
- Carbohydrate loading is recommended the evening before liver surgery and 2 hours before induction of anesthesia to improve patient outcomes, as supported by the ERAS guidelines 1.
- The decision to use bowel preparation should be made on a case-by-case basis, considering the individual patient's risk factors and the specific surgical procedure planned.
- It is crucial to follow the most recent and highest quality evidence, such as the ERAS society recommendations 1, to guide clinical decision-making and optimize patient care.
From the Research
Bowel Preparation for Hepatectomy
- The timing of bowel preparation before a hepatectomy (liver removal surgery) is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, studies have investigated the efficacy and safety of different bowel preparation methods for various surgical procedures, including colonoscopy 3, 4, 5, 6.
- For colonoscopy, bowel preparation can start anywhere from a few hours to a day before the procedure, depending on the type of preparation used 4, 5, 6.
- A study comparing low-volume polyethylene glycol plus laxative versus sennosides for colonoscopy preparation in children found that all three cleansing methods showed similar efficacy and tolerability, but none was satisfactory 4.
- Another study found that a new low-volume isosmotic polyethylene glycol solution plus bisacodyl was as effective as a split-dose 4 L polyethylene glycol for bowel cleansing prior to colonoscopy, with better tolerability and acceptability 5.
- A prospective randomized trial comparing low-dose oral sodium phosphate plus stimulant laxatives with large volume polyethylene glycol solution for colon cleansing found that the combination of oral sodium phosphate and bisacodyl was better tolerated and as efficacious as polyethylene glycol solution 6.
- Enhanced recovery after surgery (ERAS) clinical pathways in liver surgery have been studied, and may become a standard of care, but few specific recommendations have been published so far, including the timing of bowel preparation 2.