Manzoor Ali.
Randomized prospective clinical trial of no preparation versus mechanical bowel preparation before elective colorectal surgery.
Med Channel Jan ;13(1):32-5.

BACKGROUND: Mechanical bowel preparation is considered gold standard in colorectal surgery to minimize the risk of postoperative complications in relation to infection. We performed this randomized clinical trial to compare the outcome of patients, who underwent elective colorectal surgery with or without mechanical bowel preparation STUDY DESIGN: Randomized prospective study SETTING: The study was undertaken in the two units of department of surgery at Saidu Teaching Hospital, Swat, and the surgical wing of Shah Medical Center, Swat, over four years, between 1st July 2002 and 30th June 2006 METHODS: Patients scheduled for elective colorectal resection with primary anastomosis were randomized to surgery with out mechanical bowel preparation (Group 1) or to preoperative bowel preparation with normal saline (Group 2). Postoperative abdominal infectious complications and extra abdominal morbidity were recorded prospectively. RESULTS: 211 cases were included in the study, 101 in group I and 109 in group 2. Demographic, clinical and treatment characteristics did not differ significantly between the two groups. The overall rate of abdominal infectious complications (anastomotic leak, intra abdominal abscess, peritonitis and wound infection) were 10% in group 1 and 21% in group 2. Anastomotic leak occurred in 1(1%) patient in group 1 and in 6(5.5%) patients in group 2. Extra abdominal complication rates were 9% in group 1 and 18% in group 2. Hospital stay was longer for patients who had mechanical bowel preparation (mean (s.d)15(13.1) versus 10(3.8) days; CONCLUSION: Elective colorectal surgery with out mechanical bowel preparation is safe and is associated with reduced postoperative morbidity.

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