Bowel Prep

Low volume preparations better; e.g. 3x pico-prep sachets 1-2 h apart
(sodium phosphate preps associated with nephropathy; removed).
- less emesis, nausea, bloating, cramping.
Has no effect on residual bacterial species or their concentration within colon at time of surgery.

Are useful as enables easier stapler passage on L colon esp, and tactile sensation of tumours or on-table colonoscopy.
But associated with emesis, nausea, pain, dehydration and electrolyte derangements.
= High rate of negative effects

Recovery?
- no change in post-op pain, nausea, return to diet.
- but longer return to bowel function.
- also increased intra-op contamination from more liquid residual bowel contents
- interferes with pre-op nutrition.

Leak?
- no difference

Stay?
Longer hospital stay with prep.

2009 Cochrane Review (13 RCTs) and subsequent meta-analysis
No evidence of benefit for prep.
No significance for leak, collection or sepsis.
- 5% leak rate regardless of usage or not.
- across all SSI, no prep favoured.

Summary
No benefit for prep in trials, increases wound infection rates and prolongs stay.
No indication for routine use.
Except in low anterior resection
- in this case defunctioning loop ileostomy advisable to reduce clinical leak rate;
- so no point diverting stream if fecal matter remains in the large bowel.
Do have some advantages in other L sided cancers for passing staplers and feeling tumours; surgeons continue to use.
Colon manipulation better laparoscopically as well.