[Mechanical bowel preparation. A necessity or nothing more (or less) than the weight of tradition?]. / Preparar el colon para la cirugía. Necesidad real o nada más (y nada menos) que el peso de la tradición?

Mechanical bowel preparation is a traditional procedure for preparing patients for colorectal surgery. This practice aims to reduce the risk of postoperative infectious complications since colonic fecal content has classically been related to stool spillage during surgery and anastomotic disruption. However, increasing evidence against its routine use can be found in experimental studies, clinical observations, prospective studies, and meta-analyses. We performed a review of the literature on mechanical bowel preparation and its consequences. There is no clear evidence that preoperative bowel cleansing reduces the septic complications of surgery and routine use of this procedure may increase anastomotic leaks and morbidity. Therefore, the results suggest that mechanical preparation is not required in elective colon and rectal surgery and that its use should be restricted to specific indications such as small nonpalpable tumors to aid their localization during laparoscopic procedures or to enable intraoperative colonoscopy. The role of mechanical bowel preparation in rectal surgery is not well defined and further trials with a larger number of patients are required.

Preparar el colon para la cirugía. ¿Necesidad real o nada más (y nada menos) que el peso de la tradición? / Mechanical bowel preparation. A necessity or nothing more (or less) than the weight of tradition?

La preparación mecánica del colon es un componente tradicional del preoperatorio de los pacientes sometidos a cirugía colorrectal dirigido a reducir sus complicaciones infecciosas, ya que clásicamente la presencia de heces en el colon se ha asociado a contaminación intraoperatoria y dehiscencias anastomóticas. Sin embargo, en la actualidad, estudios tanto experimentales como de observaciones clínicas, trabajos prospectivos y revisiones sistemáticas de la literatura cuestionan su utilidad. Se efectúa una revisión de conjunto sobre el tema, y se concluye que, con la evidencia disponible, no está claro el beneficio de la preparación mecánica del colon y hay trabajos que muestran incluso una mayor incidencia de complicaciones en la tasa de dehiscencia anastomótica y la morbilidad con su uso sistemático, por lo que puede ser omitida en cirugía electiva y es adecuado restringirla a indicaciones concretas, como pequeños tumores, para facilitar su localización durante un abordaje laparoscópico o cuando se precise hacer una endoscopia intraoperatoria. El papel de la preparación mecánica en la cirugía rectal no está aclarado en la actualidad y se precisa de series más amplias para establecerlo (AU)

Mechanical bowel preparation is a traditional procedure for preparing patients for colorectal surgery. This practice aims to reduce the risk of postoperative infectious complications since colonic fecal content has classically been related to stool spillage during surgery and anastomotic disruption. However, increasing evidence against its routine use can be found in experimental studies, clinical observations, prospective studies, and meta-analyses. We performed a review of the literature on mechanical bowel preparation and its consequences. There is no clear evidence that preoperative bowel cleansing reduces the septic complications of surgery and routine use of this procedure may increase anastomotic leaks and morbidity. Therefore, the results suggest that mechanical preparation is not required in elective colon and rectal surgery and that its use should be restricted to specific indications such as small nonpalpable tumors to aid their localization during laparoscopic procedures or to enable intraoperative colonoscopy. The role of mechanical bowel preparation in rectal surgery is not well defined and further trials with a larger number of patients are required (AU)