• Oded Zmora, Ahmad Mahajna, Barak Bar-Zakai, Danny Rosin, Dan Hershko, Moshe Shabtai, Michael M Krausz, and Amram Ayalon.
• Department of Surgery, Sheba Medical Center and Sackler School of Medicine, Tel Aviv, Israel. ozmora@post.tau.ac.il
• Ann. Surg. 2003 Mar 1; 237 (3): 363-7.

ObjectiveTo assess whether elective colon and rectal surgery can be safely performed without preoperative mechanical bowel preparation.Summary Background DataMechanical bowel preparation is routinely done before colon and rectal surgery, aimed at reducing the risk of postoperative infectious complications. However, in cases of penetrating colon trauma, primary colonic anastomosis has proven to be safe even though the bowel is not prepared.MethodsPatients undergoing elective colon and rectal resections with primary anastomosis were prospectively randomized into two groups. Group A had mechanical bowel preparation with polyethylene glycol before surgery, and group B had their surgery without preoperative mechanical bowel preparation. Patients were followed up for 30 days for wound, anastomotic, and intra-abdominal infectious complications.ResultsThree hundred eighty patients were included in the study, 187 in group A and 193 in group B. Demographic characteristics, indications for surgery, and type of surgical procedure did not significantly differ between the two groups. Colo-colonic or colorectal anastomosis was performed in 63% of the patients in group A and 66% in group B. There was no difference in the rate of surgical infectious complications between the two groups. The overall infectious complications rate was 10.2% in group A and 8.8% in group B. Wound infection, anastomotic leak, and intra-abdominal abscess occurred in 6.4%, 3.7%, and 1.1% versus 5.7%, 2.1%, and 1%, respectively.ConclusionsThese results suggest that elective colon and rectal surgery may be safely performed without mechanical preparation.

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