Bowel prep - yes or no?. Ian Botterill Dept Colorectal Surgery St James’ University Hospital Leeds. Goligher (1970’s). “…there are great advantages to operating on an empty colon …if the growth is stenotic, 10-14 days should be set aside
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Bowel prep- yes or no?
Dept Colorectal Surgery
St James’ University Hospital
“…there are great advantages to operating on an empty colon
…if the growth is stenotic, 10-14 days should be set aside
… excellent preparation may be obtained with 30l via the irrigation machine
…my preference is 5-6 days, initial softening then vigorous expulsion with castor oil … finally, massive colonic irrigation in the terminal phase ….this process can be exhausting for frail, elderly patients
….some suggest that it may lead to hypovolaemia and circulatory imbalance”
Surgery of the Anus, Rectum & Colon 3rd edition 1975
“this paper which challenges accepted surgical practice, is a veritable little bomb of a paper, brief, iconoclastic and disrespectful of hallowed tradition in surgery”Professor David Johnston, BJS 1987;74:553-4
- ↓ cardiac output / shock- ↓ coronary artery filling- colonic mucosal ischaemia
Electrolyte disturbance- fits- dysrhythmias- myopathy- nausea
Diarrhoea- lack of sleep &vitality
Wilson et al. BMJ 1999;318:1099-1103
L.o.S. only quoted in 1/9 articles reviewed!
24hrs & 48hrs post sigmoid colectomy
Summary of published data (to 2004)
“results of this show the necessity of completing more, properly designed trails” …blinding & stratification …consider pre-op radiotherapy …inclusion & exclusion criteria …define discharge criteria, dropout & outcome measures
* Use enema