Mechanical bowel preparation for elective colorectal surgery

NICE Quality and Productivity Case Studies
Queen's University Belfast
Publication date:
13 April 2017


NICE summary of Cochrane review conclusions  Evidence shows that mechanical bowel preparation is not effective for improving outcomes in patients undergoing elective colorectal surgery and should not be used routinely. It should be reserved for procedures in which intraoperative colonoscopy might be performed or close visualisation of the bowel mucosa is needed.   Stopping or reducing the routine use of mechanical bowel preparation in patients undergoing elective colorectal surgery is likely to lead to improved quality of patient care, improved patient experience and productivity savings. Mechanical bowel preparation should still be used at the surgeon’s discretion during procedures to identify pathology or when intraoperative colonoscopy might be performed.    The ‘Implications for practice’ section of the Cochrane review stated:  ‘Prophylactic mechanical bowel preparation prior to colonic surgery has not been proven to be valuable for patients. This review suggested that in cases of well-defined location and size of the lesion, the surgeon and his patient are free to choose. Bowel cleansing should be considered when a surgeon needs to identify pathology - for example, a small tumour - or when an intra-operative colonoscopy might be performed.’