The effect of bowel preparation on colonic surgery

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Abstract
In colorectal surgery, formed feces within the colon pose an obstructive threat to a colonic anastomosis and an infective threat to the patient. If the colon is not cleared of feces before operation, and if antibiotic prophylaxis is not given, anastomotic dehiscence and postoperative sepsis are common after colorectal operations. Preoperative mechanical bowel preparation reduces the obstructive threat by clearing the colon of feces, and with good bowel preparation the incidence of anastomotic dehiscence is reduced from 24% to 7%.Sepsis after colorectal surgery is caused by aerobic and anaerobic bacteria. Antibiotics effective against both types of organisms are, therefore, required for effective prophylaxis. Oral antibiotic prophylaxis does not diminish significantly the fecal infective threat but, nevertheless, reduces the incidence of postoperative sepsis to 15–20%. Oral prophylaxis may be complicated by diarrhea and antibiotic‐associated colitis. After systemic prophylaxis, the incidence of postoperative sepsis can be reduced to 5–10%, and antibiotic‐associated diarrhea and colitis are less common.

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