From the Guidelines
There is no need for bowel prep before undergoing a right hemicollectomy, as the current evidence suggests that mechanical bowel preparation (MBP) does not provide significant clinical benefits in terms of reducing anastomotic leak rates, surgical site infection, or mortality 1. When considering the outcomes of morbidity, mortality, and quality of life, the most recent and highest quality study indicates that MBP alone is not associated with any significant difference in clinical outcomes compared to no MBP 1. Key points to consider include:
- A meta-analysis of 36 studies comparing MBP versus no MBP in elective colorectal surgery found no significant difference in anastomotic leak rates, surgical site infection, or mortality 1.
- The combination of oral antibiotic preparation and systemic antibiotics may reduce morbidity after colorectal surgery, but this does not necessarily require MBP 1.
- A recent meta-analysis of 23 randomized controlled trials and 8 cohort studies demonstrated that systemic antibiotic use alone was associated with a significant reduction in surgical site infection, and the addition of oral antibiotic preparation to MBP in the setting of systemic antibiotics significantly reduced the incidence of surgical site infection 1. However, the largest observational study to date arising from the ACS NSQIP database found that oral antibiotic preparation alone was protective of surgical site infection, anastomotic leak, ileus, and major morbidity 1. In the context of real-life clinical medicine, the decision to use bowel prep before a right hemicollectomy should be based on the individual patient's needs and the surgeon's preference, taking into account the potential benefits and risks of MBP 1.
From the Research
Bowel Preparation for Right Hemicollectomy
The need for bowel preparation before undergoing a right hemicollectomy is a topic of ongoing debate.
- The use of bowel preparation has been traditionally thought to decrease the risk of infection by reducing the bacterial load in the colon 2.
- However, recent studies have suggested that mechanical bowel preparations may not be necessary, and that dietary restrictions before surgery may also be obsolete 2.
- Some studies have found that the addition of oral antibiotics to mechanical bowel preparation may further reduce the risk of infection, but this approach is still controversial 3, 4.
- A review of recent literature found that guidelines are changing, and there is no consistent regimen for bowel preparation before colorectal surgery, with some studies suggesting that oral antibiotics alone may be sufficient 4.
- Another study found that mechanical bowel preparation remains the standard of care in North America, but that omission of mechanical bowel preparation for elective colorectal surgery is not only feasible but potentially preferable 5.
Types of Bowel Preparation
Different types of bowel preparation have been studied, including:
- Mechanical bowel preparation using osmotic, laxative, or combination regimens 2
- Oral antibiotics alone or in combination with mechanical bowel preparation 3, 4
- Dietary restrictions before surgery 2
- Polyethylene glycol solution and sodium phosphate solution for bowel preparation for colonoscopy 6
Controversies and Future Directions
There is still controversy surrounding the use of bowel preparation before colorectal surgery, with some studies suggesting that it may not be necessary, while others recommend its use to reduce the risk of infection.
- Further research is needed to establish a consistent regimen for bowel preparation before colorectal surgery, taking into account the location of the lesion and the surgical method 3.
- The use of oral antibiotics alone or in combination with mechanical bowel preparation is an area of ongoing research, with some studies suggesting that it may be a viable alternative to traditional bowel preparation methods 4.