Background: Mechanical bowel preparation (MBP) of gut is routinely done before colorectal surgeries in most surgical departments all over the globe. This gut preparation is aimed at reducing the risk of postoperative infections in patients undergoing colorectal surgery. Even though recent studies are more in favor of operating on gut without bowel preparation, controversies still exist. The aim of our study was to assess whether elective colorectal surgeries can be performed safely without preoperative MBP. Methods: Patients undergoing elective colorectal surgeries were prospectively randomized into two groups with the help of random number table method; Group-1 had mechanical bowel preparation with polyethylene glycol (MBP group) before surgery, and Group-2 had no mechanical bowel preparation (NMBP group) before surgery. All patients in the study groups were followed up for at least 2 months after surgery for wound infection, anastomotic leak and intra-abdominal infections. Results: Two hundred fourteen patients were included in this hospital-based systematic prospective randomized trial: 104 patients in Group-1 and 98 patients in Group-2. Twelve patients were excluded from the study. The type of surgical procedure and type of anastomosis did not significantly differ between two groups. There was no difference in surgical infections between two groups. The overall infection rate was 39.4% in Group-1 and 32.6% in Group-2 (p = 0.31). Wound infection (p = 0.45), anastomotic leak (p = 0.45) and intra-abdominal/pelvic collection (p = 0.62) occurred in 3.8%, 3.8% and 6.7% versus 6.1%, 2% and 5.1% in Group-1 (MBP group) and Group-2 (NMBP group) respectively. Our results showed that MBP does not offer any specific benefit in elective colorectal surgeries but in real sense may add to some problems, which, however, did not achieve a statistical significance. Conclusions: Our study proved that no advantage is gained by pre-operative mechanical bowel preparation in elective colorectal surgery and can be easily avoided in order to save patients from unwanted exhaustion, distress and adverse effects related to it. It is actually the mindset that makes us to believe that MBP will reduce the incidence of infections rather than the evidence from literature. We conclude from our study that all types of elective colorectal surgeries can be performed safely without subjecting patients to mechanical bowel preparation before surgery. Highlights:

Background: Research of so many years from the procurable world data has shown that the reasons for most colorectal cancers occur due to change in life style the type of diet, smoking as well as the influence of the surrounding environment in which man lives and increasing age with only a minority of cases associated with genetic disorders. Colorectal cancer is the third most commonly diagnosed cancer. In the first half of the 20th century, mortality from colorectal surgery often exceeded 20%, mainly attributed to sepsis. Methods: The randomized prospective study was conducted on 202 colorectal cancer patients in the department of Colorectal division of General and Minimal Invasive surgery" Sher-i-Kashmir Institute of Medical Sciences, Srinagar. Results: Mean age of patients in Group 1 (with no mechanical bowel preparation (NMBP)) was 51±18.15 years while as same was 50±17.76 years for Group 2 (with mechanical bowel preparation (MBP)). Age range for Group 1 was 16-87 years and16-85 years for Group 2. Regarding outcomes, wound infections were 6.1% and 3.8% in Group 1 and Group 2 respectively. While disruption of anastomosis were 2.0% and 3.8% in group A and B respectively. Conclusions: Statistically no gross difference in terms of morbidity and mortality was found between the use of mechanical bowel preparation versus no use of mechanical bowel preparation in elective colorectal surgery. Elective Colorectal Surgery can safely be performed without enduring MBP in it as it does not possess any sorts of benefits.

a p o l l o m e d i c i n e 1 2 s ( 2 0 1 5 ) S10-S29 S13during perianal surgeries in two, acute obstetric injury in two and postpartum delayed fistula in the remaining two. MRI pelvis was done in all these patients prior to surgery. Amongst these, two patients already had a diversion stoma at time of referral. Patient outcomes were assessed after surgical repair as the percentage of patients with a healed fistula after a median follow-up of 6 months.Results: All 6 patients had complete fistula closure with no recurrence. However, 2 patients had complications in the postoperative period. In one, there was partial necrosis of gracilis flap needing debridement but fistula healed completely in 3 months. The second patient had superficial wound infection, which was dealt with conservatively.Conclusion: Gracilis muscle interposition is an excellent option for patients with complex perianal fistula with minimal morbidity and high success rate.