Improvements in mechanical bowel preparation for elective colorectal surgery

Abstract

PURPOSE: This study was undertaken to determine whether a mechanical bowel preparation with 2 liters of polyethylene glycol solution combined with a laxative (Group A) increases the acceptability of bowel preparation and reduces discomfort compared with 4 liters of polyethylene glycol solution (Group B). METHODS: One hundred patients undergoing an elective colorectal resection were included in a prospective, randomized study. Acceptability (nausea, vomiting, abdominal cramps, discomfort from insertion of the nasogastric tube, and anal discomfort) was assessed using visual analog scales. Efficacy of bowel lavage was scored intraoperatively by a blinded surgeon. RESULTS: Overall acceptability was 5.1 +/- 2.8 in Group A patients and 5.6 +/- 2.6 in Group B patients (P = 0.5). The incidence and visual analog score for nausea, vomiting, anal discomfort, and cramps were not different between groups. Excellent efficacy of bowel preparation was shown in 94 percent of patients in Group A and 84 percent of patients in Group B (P = 0.5). The incidence of septic complications was 2 percent in Group A patients and 12 percent in Group B patients (P = 0.06). CONCLUSION: Because the acceptability of both cleansing regimens were not different, 2 liters of polyethylene glycol plus Prepacol should be preferred because the amount of fluid administered to clean the bowel is reduced and the nasogastric tube can always be avoided.