The Role of Mechanical Bowel Preparation before Ileal Urinary Diversion: A Systematic Review and Meta-Analysis

Abstract

Background: Although the use of mechanical bowel preparation (MBP) is still widely promoted as the dogma before patients undergo ileal urinary diversion, an increasing number of clinical trials have suggested that there is no benefit. Thus, we performed a meta-analysis to evaluate the efficacy of MBP in ileal urinary diversion surgery. Methods: A literature search was performed in electronic databases, including PubMed, Embase, Science Citation Index Expanded as well as the Cochrane Library and the Cochrane Clinical Trials Registry, from 1966 to January 1, 2013. Clinical trials comparing outcomes of MBP versus no MBP for ileal urinary diversion surgery were included in the meta-analysis. Pooled odds ratios with 95% confidence intervals were calculated using the fixed- or random-effects models. Results: In total, two randomized controlled trials and five cohort studies were included in this meta-analysis. The primary outcomes, such as bowel leak and bowel obstruction, showed no statistical difference between the two groups. Additionally, the overall mortality rate and death rate related to operation also manifested that MBP does not offer an advantage over the no MBP. Conclusion: This meta-analysis suggests that MBP does not reduce the incidence of perioperative complications in urinary diversion compared with no MBP. However, large randomized controlled clinical trials are needed to confirm this finding.

Impact of mechanical bowel preparation in elective colorectal surgery: A meta-analysis

“…Meta-analyses[ 8 - 12 ] have been published on MBP in elective colorectal surgery showing mixed results, with most studies demonstrating no difference in infective complications between patients receiving MBP or control treatment, although control treatment varied significantly between the use of a rectal enema or absolutely no preparation. Similar results have been found in gynaecological[ 13 , 14 ] and urological[ 15 , 16 ] surgery where studies have shown no benefits in visualisation, bowel handling or complication rates between patients treated with bowel preparation and those given no bowel preparation. As a result of this inconclusive evidence, several studies have established that practice varies significantly between countries, and even surgeons in the same institution[ 17 , 18 ].…”

Is mechanical bowel preparation still necessary for gynecologic laparoscopic surgery? A meta‐analysis

“…In recent years, more and more studies have found that MBP has no proven benefits and should be omitted in most colorectal and urologic surgeries (1,(17)(18)(19)(20)(21). However, studies specifically related to gynecologic patients are scant.…”

Does Mechanical Bowel Preparation Ameliorate Surgical Performance in Anterior Lumbar Interbody Fusion?

“…In addition, it might induce electrolyte disturbances, dehydration, insomnia, general weakness on the day of surgery, and gastrointestinal discomfort postoperatively. 5,6 Although systemic reviews could not demonstrate any significant benefit of MBP regarding intraoperative and perioperative complications, [7][8][9][10] MBP is still performed in many institutes before various transabdominal surgeries. [11][12][13] The anterior approach to the lumbar spine can allow direct and wide exposure of the anterior column, which has many advantages in spinal reconstruction surgery.…”