Abstract
Background
A recent meta-analysis has questioned the value of bowel preparation in patients undergoing colorectal resection. The aim of this clinical trial was to evaluate whether a single phosphate enema was as effective as oral polyethylene glycol (PEG) solution in preventing anastomotic leakage.
Methods
Patients were randomized to receive either a single phosphate enema or 3 litres of oral PEG solution before surgery. Patients were followed for a minimum of 6 weeks to detect anastomotic leakage.
Results
There were 147 patients in each group and the groups were evenly matched for putative risk factors at baseline. Patients in the enema group had more anastomotic leaks requiring reoperation than those in the PEG group (4ยท1 versus 0 per cent, P = 0ยท013; relative risk 2ยท04 (95 per cent confidence interval (c.i.) 1ยท82 to 2ยท30)). The mortality rate was higher in the PEG group (2ยท7 versus 0ยท7 per cent, P = 0ยท176; odds ratio 1ยท62 (95 per cent c.i. 0ยท45 to 36ยท98)).
Conclusion
Bowel preparation with a phosphate enema was associated with an increased risk of anastomotic leakage requiring reoperation compared with oral PEG. These results do not support the routine use of a phosphate enema in patients undergoing elective colorectal surgery.