Laparoscopic colectomy with and without routine mechanical bowel preparation before operation: a comparative study

Abstract

BACKGROUND: Although it is a common belief that preoperative mechanical bowel preparation (MBP) reduces the risk of complications after elective colorectal operations, many studies have shown that MBP does not improve operative outcomes. However, most of the evidence was from open surgery. The study evaluates the outcomes of elective laparoscopic colectomy with and without bowel preparation. METHODS: This is a retrospective comparative study of patients who had elective laparoscopic colectomy for colon cancer without preoperative MBP in our centre during the period of October 2009 to July 2011 (No-MBP group) and patients with MBP during Jan 2007 – May 2009 (MBP group). Patient demographics, operative outcomes, morbidity and mortality were retrieved from a prospective database and comparison between the two groups was compared. RESULTS: The No-MBP group had 97 patients and the MPB group had 159 patients. The mean age of No-MBP and MBP groups were both 70.7 (p = 0.988). Conversion rates in No-MBP and MBP groups were 5.2% and 6.9% respectively (p = 0.572). The ASA score of the patients, size of tumour and stage of disease were all similar in both groups. There were no significant difference between two groups in operative time, blood loss and hospital stay. The anastomotic leakage rates were the same (1%) in both groups. Two patients in No-MBP group (2.2%) and 1 patient (0.7%) in MBP group had intraabdominal collection (p = 0.560). Wound infection rate were 4.1% and 3.8% in No-MBP group and MBP group respectively (p = 1.000). Other surgical complication included postoperative bleeding [3 patients (3.1%) in No-MBP group & 1 patient (0.6%) in MBP group; p=0.560], intestinal obstruction [4 patients (4.1%) in No-MBP group & 1 patient (0.6%); p=0.07]. Total surgical morbidity rate was 11.3% in No-MBP group and 8.2 % in MBP group (p = 0.399). Six patients (6.2%) in No-MBP group and 4 patients (2.5%) in MBP group required reoperations (p=0.186). There was no mortality in No-MBP group and one mortality (0.6) in MBP group (p= 1.000). CONCLUSION: Preoperative MBP offers no additional benefits to laparoscopic colectomy for colon cancer and routine administration of preoperative MBP is not indicated.