ObjectiveTo determine the benefits and harms of mechanical bowel preparation(MBP) in elective colorectal surgery. MethodsCochrane systematic evaluation was used to search through Cochrane libraries of clinical comparative trials, PubMed, Embase, Cancer Lit, and the Chinese BioMedical Literature on disc. The quality of literatures was independently evaluated and cross-checked by two evaluators, indicator for assessment including anastomotic leak, overall surgical site infection(SSI), extra-abdominal septic complications, wound infections, reoperation or second intervention rate, and death. The results were analysed with RevMan 5.1 software. ResultsFourteen RCTs were included in this analysis with a total number of 5 373 patients. Comparing with no MBP for elective colorectal surgery, the study results showed that MBP had not reduce any postoperative complications when concerning anastomotic leak[OR(95% CI), 1.08(0.82-1.43);P=0.56];overall SSI[OR(95% CI), 1.26(0.94-1.68);P=0.12];extra-abdominal septic complications[OR(95% CI), 0.98(0.81-1.18);P=0.81];wound infections[OR(95% CI), 1.21(1.00-1.46);P=0.05];reoperation or second intervention rate[OR(95% CI), 1.11(0.86-1.45);P=0.42], and death[OR(95% CI), 0.97(0.63-1.48);P=0.88]. ConclusionNo evidence supporting the use of MBP in patients undergoing elective colorectal surgery. MBP should be omitted in routine clinical practice.
Objective We searched and reviewed medical evidence to find the guide of bowel preparation we should choose before large bowel preparation. Method Firstly, we put forward clinical questions. Secondly, we searched medical evidence from PubMed, MEDLINE, EMbase, Cochrane Library, Science and ACP in recent 10 years. And then we reviewed the results. Results We finally identified 17 literatures including 2 system reviews, 6 meta-analyses and 9 randomized control trials which included 4 multicentre randomized clinical trials. Most of literature suggested that there was no evidence showing the benefit of mechanical bowel preparation (MBP). No MBP before large bowel surgery would not increase rate of anastomotic leakage. On the contrary, MBP may increase the percentage of anastomotic leakage and wound infection. Considering the research with the clinical situation, we produced a new method of simplified MBP to treat the patient. It reached the predictive effect. Conclusion No evidence of systematic review and meta-analysis supports the benefit of BMP. The new simplified bowel preparation before surgery in West China Hospital was worthy to test.
Objective To investigate the efficacy of dietary management based on the principles of enhanced recovery after surgery (ERAS) in bowel preparation for patients undergoing colonoscopy. Methods Patients undergoing colonoscopy procedures in the Department of Gastroenterology at West China Hospital, Sichuan University between December 2023 and December 2024 were randomly assigned to a control group and a trial group. The control group received conventional dietary management, comprising a self-prepared low-residue diet with fasting commencing at 22:00 on the preoperative evening. The trial group received dietary management based on the ERAS protocol, comprising pre-packaged low-residue meals on the day before surgery (lunch, dinner, and a 22:00 snack) plus 200 mL of clear liquids consumed 2 hours preoperatively. The Boston Scale and a subjective experience questionnaire (assessing preoperative and postoperative hunger, thirst, adverse reactions, etc.) were used to evaluate and compare bowel preparation quality and patient subjective experiences between the two groups. Results A total of 370 patients were included, comprising 194 in the control group and 176 in the trial group. Compared with the control group, the trial group showed no statistically significant difference in the Boston score for bowel preparation, the rate of adequate bowel preparation (78.41% vs. 71.65%), or the incidence of adverse reactions during bowel preparation or postoperatively (P>0.05). Patients in the trial group demonstrated higher subjective satisfaction with bowel cleansing (81.82% vs. 68.04%) and lower preoperative hunger [1.00 (0.00, 4.00) vs. 2.00 (0.00, 5.00)], with statistically significant differences (P<0.05). Conclusions Dietary management based on the ERAS concept does not increase the risk of bowel preparation failure or the incidence of adverse reactions during bowel preparation or postoperatively, compared with self-prepared low-residue diets. However, it reduces patients’ preoperative hunger and improves subjective satisfaction with bowel cleansing, making it worthy of promotion and application in clinical practice.