What is the appropriate bowel preparation for patients with a history of hemicolectomy (partial colectomy)?

From the Guidelines

Patients with a history of hemicolectomy (partial colectomy) should not undergo routine mechanical bowel preparation (MBP).

Rationale

• The use of MBP has been associated with adverse physiologic effects, such as dehydration, and has not been shown to reduce the risk of postoperative complications, including anastomotic leakage and surgical site infections 1.
• The ERAS society recommendations suggest that MBP should not be used routinely in colonic surgery, as it can cause dehydration and discomfort without providing any clinical advantage 1.
• Some studies suggest that the combination of oral antibiotic preparation and MBP may reduce morbidity after colorectal surgery, but the evidence is not strong enough to support its routine use 1.
• The selective use of MBP is recommended, particularly in patients undergoing elective low rectal surgery or having a planned elective de-functioning ileostomy or colostomy 1.

Key Points

• MBP alone with systemic antibiotic prophylaxis has no clinical advantage and can cause dehydration and discomfort 1.
• The combination of MBP and oral antibiotics may have some benefits, but the evidence is limited and further high-quality studies are needed to support its use 1.
• Patients with a history of hemicolectomy should be managed on a case-by-case basis, taking into account the specific surgical procedure and individual patient factors 1.

From the Research

Bowel Preparation for Patients with a History of Hemicolectomy

• The necessity of bowel preparation for patients with a history of hemicolectomy (partial colectomy) is a topic of ongoing debate in the medical community 2, 3, 4, 5, 6.
• Some studies suggest that full bowel preparation, including mechanical bowel preparation with nonabsorbable oral antibiotics, may be associated with a decreased rate of postoperative infectious complications 2, 3.
• However, other studies have found that mechanical bowel preparation does not confer significant benefits in reducing postoperative complications, and it may be safe to forego it prior to elective colectomy 4, 5.
• A randomized controlled trial found that elective laparoscopic colectomy without mechanical bowel preparation is safe and offers acceptable postoperative morbidity 5.
• A survey of surgeons in the UK found that a large proportion of patients still receive full bowel preparation despite recent advice to the contrary, with varying practices for different types of colectomy procedures 6.
• The use of oral antibiotics in addition to mechanical bowel preparation may provide additional benefits in reducing postoperative complications, but the evidence is not consistent across all studies 2, 3, 4.
• The decision to use bowel preparation for patients with a history of hemicolectomy should be made on a case-by-case basis, taking into account the individual patient's risk factors and the type of surgery being performed 2, 3, 4, 5, 6.