EVALUATION OF MECHANICAL BOWEL PREPARATION IN ELECTIVE COLORECTAL SURGERY

Abstract

Background: Complications in elective colorectal surgery, such as surgical site infection and anastomotic leakage, wound infection and abdominal abscess frequently resulted from inadequate bowel preparation practices. Mechanical bowel preparation (MBP) was employed to mitigate these risks by thoroughly cleansing the bowel before surgery. However, due to conflicting research findings, a study was conducted to assess MBP's specific impact on our patient population, aiming to provide clarity on its role in optimizing surgical outcomes.  

Objective:  To evaluate the impact of mechanical bowel preparation (MBP) compared to non-MBP on surgical outcomes.

Methods: A total of 132 patients undergoing colorectal surgery at Surgical Unit II, Bolan Medical Complex Hospital Quetta, meeting inclusion criteria were enrolled after taking informed written consent and were randomly divided into two equal groups. Patients in Group A underwent colorectal surgery following MBP, while Group B underwent surgery without MBP. Patients on MBP fasted on a liquid diet until midnight pre-surgery; others had a low-residue diet until then. Both groups took 10 mg diazepam and 150 mg ranitidine orally for anxiety and sleep. Intravenous antibiotics (metronidazole 500 mg, ceftriaxone 1g) were given at induction and post-op for 72 hours. All the procedure was performed as per standard protocol of the hospital and data was noted for analysis.

Results: Mean age of the patients was 49.94 years (±9.60). In terms of gender distribution, 56.8% (75 patients) were male, and 43.2% (57 patients) were female. Regarding their place of residence, 56.1% (74 patients) were from rural areas, and 43.9% (58 patients) were from urban areas. Moreover, comparison of baseline characteristics between the groups showed insignificant difference with p-value>0.05. The prevalence of constipation was 59.8% whereas bleeding was observed in 58.3% of the patients. Abdominal pain was reported by 29.5% of the patients, anorexia affected 58.3% of the patients, and weight loss was noted in 47.7% of the patients. For wound infection, Group A had 23 cases (34.8%) compared to 17 cases (25.8%) in Group B (p=0.256). Abdominal abscess occurred in 17 cases (25.8%) and 15 cases (22.7%) in Group A and B (p=0.685), respectively. Anastomotic leak was reported in 7 cases (10.6%) in Group A and 5 cases (7.6%) in Group B (p=0.545). Surgical site infection was noted in 10 cases (15.2%) in Group A and 11 cases (16.7%) in Group B (p=0.812).

Across all measured outcomes, difference between the groups was not statistically significant,

suggesting similar incidences of these complications between the groups.

Conclusion: This study found no significant differences in surgical outcomes between MBP and non-MBP groups, challenging MBP's routine use and highlighting the need for evidence-based guidelines in colorectal surgery.