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
= High rate of negative effects
- 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
- interferes with pre-op nutrition.
- no difference
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.
No benefit for prep in trials, increases wound infection rates and
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
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.