Orthograde bowel lavage with or without oral antibiotics: Current evidence

Colorectal surgery is one of the most common visceral surgical procedures and is associated with an increased risk of infectious complications. Preoperative bowel preparation is intended to help reduce the risk of such complications. To this end, methods used include orthograde bowel lavage to reduce fecal contamination, the administration of oral antibiotics to reduce bacterial colonization of the mucosa or a combination of mechanical irrigation and oral antibiotics; however, there is disagreement as to which method is most effective for preoperative bowel preparation. Within the framework of a Cochrane analysis no positive effect could be demonstrated for purely mechanical bowel preparation; however, a combination of mechanical irrigation and oral antibiotics reduces the risk of wound infections and anastomotic insufficiency. Whether oral antibiotic bowel preparation alone without additional mechanical bowel irrigation can achieve the same effect and thus mechanical irrigation can be dispensed with, remains questionable in view of the current evidence.