Mechanical and oral antibiotic bowel preparation (MOABP) does not reduce surgical site infections (SSIs) or the overall morbidity of colon surgery versus no bowel preparation (NBP), according to a study, ‘Mechanical and oral antibiotic bowel preparation versus no bowel preparation for elective colectomy (MOBILE): a multicentre, randomised, parallel, single-blinded trial,’ published in The Lancet.
In recent decades, colectomy patients in Europe or surgical procedures targeted at the colon, have not been routinely subjected to what is known as bowel preparation, where the bowel is emptied before the operation. In the US, on the other hand, cleansing the bowel is relatively common.
Several extensive retrospective studies conducted in the US were published a few years ago, indicating that bowel preparation combined with the preoperative oral administration of antibiotics appeared to significantly reduce surgical site infections. Based on these results, American surgical associations recommended bowel preparation before colectomies. In Finland, the attitude to this practice has so far remained somewhat reserved due to the absence of randomised studies.
"Bowel preparation is a stressful procedure for the patient, so conducting it is only justified when it genuinely benefits the patient," said Dr Laura Koskenvuo, gastrointestinal surgeon at the Helsinki University Hospital. “However, not a single randomised follow-up study had been conducted on the topic, so we decided to carry one out ourselves.”
Koskenvuo and colleagues randomly assigned (1:1) 396 patients undergoing colon resection to either MOABP or NBP in four hospitals in Finland (March 2016 to August 2018). MOABP consisted of drinking 2 litres of polyethylene glycol and 1 litre of clear fluid before 6pm the day before surgery and taking 2 grams of neomycin orally at 7pm and 2 grams of metronidazole orally at 11pm the day before surgery.
The researchers found that SSIs were detected in 7 percent of 196 patients assigned to MOABP and in 11 percent of 200 patients assigned to NBP (p=0.17). Anastomotic dehiscence was reported in 4 percent of both groups. Re-operations were necessary in 8 percent of the MOABP group versus 7 percent of the NBP group. Within 30 days of surgery, two patients died in the NBP group versus none in the MOABP group.
"According to our findings, there were no differences in treatment outcomes between the groups. Bowel preparation did not reduce surgical site infections or the total number or severity of surgical complications,” said notes Dr Ville Sallinen, gastrointestinal surgeon and adjunct professor at the Helsinki University Hospital. “Neither was there any difference in the number of days spent at the hospital. It appears that this stressful procedure provides no benefit to patients."
The authors concluded, “We therefore propose that the current recommendations of using MOABP for colectomies to reduce SSIs or morbidity should be reconsidered.”