Is a bowel prep necessary before colostomy reversal?

Another paper that supports omitting bowel preps before pediatric bowel operations came out in this month’s issue of JPS. In this study, the authors conducted a retrospective, multi-institution study and compared the outcome of 272 children who underwent colostomy reversal with and without (187 vs. 85) a polyethylene glycol bowel prep.

The authors noted a significantly higher rate of wound infection (14.4% vs. 5.8%), as well as a longer hospital stay (5.6% vs. 4.4%) in the group who underwent a bowel prep. Additionally, they noted that the risk for other complications such as abdominal abscess formation (~1%) and ansastomotic leak (~1%) was the same whether a bowel prep was used or not.

Reasons given for the potential deleterious effects of the bowel prep included the characteristics of liquid stool (bowel prep) that make it more difficult to contain, the fact that the bacterial load in prep’d stool is not necessarily lower than unprepped stool (papers sited), and the potential harmful effect of the bowel prep on the integrity of the bowel mucosa.

As with all retrospective studies, the authors acknowledged the limitations of their results, but stressed that, except for intra-pelvic rectal surgery, a bowel prep is likely unnecessary for colonic surgery in children.

Reference:
Serrurier K et al. A multicenter evaluation of the role of mechanical bowel preparation in pediatric colostomy takedown. JPS (2012);47:190-193