Preparing the bowel for surgery: rethinking the strategy

Abstract

Whether to administer purgative cleansing and oral antibiotics before colon surgery as a method to prevent postoperative infections, once standard of care, is now being considered unnecessary with today’s advancements of care. A new study questions the efficacy of this bowel preparation approach with a prospective randomized trial.

Figure 1.. Preparing the bowel for surgery in the era of the microbiome.

When non-selective approaches to eliminate all potential pathogens from the gut are used before colon surgery such as with mechanical and oral antibiotic bowel preparation, both the microbiome and pathobiome are affected. The downside of this approach is the disruption of the delicate balance between pathogen proliferation and its natural suppression by refaunation of the normal microbiota under such circumstances. On the other hand, empiric use of intravenous antibiotics alone might not eliminate surgical site infection (SSI)-related pathogens, especially those that have become antibiotic resistant. Genetic sequencing and dynamic tracking of the microbiome following surgery is needed to inform the development and design of ‘Bowel Prep 2.0’.