Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb 7;2(2):CD014909.
doi: 10.1002/14651858.CD014909.pub2.

Preoperative combined mechanical and oral antibiotic bowel preparation for preventing complications in elective colorectal surgery

Maria A Willis  1 , Ingrid Toews  2 , Sophia Lv Soltau  1 , Jörg C Kalff  1 , Joerg J Meerpohl  2   3 , Tim O Vilz  1
Affiliations

Preoperative combined mechanical and oral antibiotic bowel preparation for preventing complications in elective colorectal surgery

Maria A Willis et al. Cochrane Database Syst Rev. .

Abstract

Background: The success of elective colorectal surgery is mainly influenced by the surgical procedure and postoperative complications. The most serious complications include anastomotic leakages and surgical site infections (SSI)s, which can lead to prolonged recovery with impaired long-term health. Compared with other abdominal procedures, colorectal resections have an increased risk of adverse events due to the physiological bacterial colonisation of the large bowel. Preoperative bowel preparation is used to remove faeces from the bowel lumen and reduce bacterial colonisation. This bowel preparation can be performed mechanically and/or with oral antibiotics. While mechanical bowel preparation alone is not beneficial, the benefits and harms of combined mechanical and oral antibiotic bowel preparation is still unclear.

Objectives: To assess the evidence for the use of combined mechanical and oral antibiotic bowel preparation for preventing complications in elective colorectal surgery.

Search methods: We searched MEDLINE, Embase, CENTRAL and trial registries on 15 December 2021. In addition, we searched reference lists and contacted colorectal surgery organisations.

Selection criteria: We included randomised controlled trials (RCTs) of adult participants undergoing elective colorectal surgery comparing combined mechanical and oral antibiotic bowel preparation (MBP+oAB) with either MBP alone, oAB alone, or no bowel preparation (nBP). We excluded studies in which no perioperative intravenous antibiotic prophylaxis was given.

Data collection and analysis: We used standard methodological procedures as recommended by Cochrane. Pooled results were reported as mean difference (MD) or risk ratio (RR) and 95 % confidence intervals (CIs) using the Mantel-Haenszel method. The certainty of the evidence was assessed with GRADE.

Main results: We included 21 RCTs analysing 5264 participants who underwent elective colorectal surgery. None of the included studies had a high risk of bias, but two-thirds of the included studies raised some concerns. This was mainly due to the lack of a predefined analysis plan or missing information about the randomisation process. Most included studies investigated both colon and rectal resections due to malignant and benign surgical indications. For MBP as well as oAB, the included studies used different regimens in terms of agent(s), dosage and timing. Data for all predefined outcomes could be extracted from the included studies. However, only four studies reported on side effects of bowel preparation, and none recorded the occurrence of adverse effects such as dehydration, electrolyte imbalances or the need to discontinue the intervention due to side effects. Seventeen trials compared MBP+oAB with sole MBP. The incidence of SSI could be reduced through MBP+oAB by 44% (RR 0.56, 95% CI 0.42 to 0.74; 3917 participants from 16 studies; moderate-certainty evidence) and the risk of anastomotic leakage could be reduced by 40% (RR 0.60, 95% CI 0.36 to 0.99; 2356 participants from 10 studies; moderate-certainty evidence). No difference between the two comparison groups was found with regard to mortality (RR 0.87, 95% CI 0.27 to 2.82; 639 participants from 3 studies; moderate-certainty evidence), the incidence of postoperative ileus (RR 0.89, 95% CI 0.59 to 1.32; 2013 participants from 6 studies, low-certainty of evidence) and length of hospital stay (MD -0.19, 95% CI -1.81 to 1.44; 621 participants from 3 studies; moderate-certainty evidence). Three trials compared MBP+oAB with sole oAB. No difference was demonstrated between the two treatment alternatives in terms of SSI (RR 0.87, 95% CI 0.34 to 2.21; 960 participants from 3 studies; very low-certainty evidence), anastomotic leakage (RR 0.84, 95% CI 0.21 to 3.45; 960 participants from 3 studies; low-certainty evidence), mortality (RR 1.02, 95% CI 0.30 to 3.50; 709 participants from 2 studies; low-certainty evidence), incidence of postoperative ileus (RR 1.25, 95% CI 0.68 to 2.33; 709 participants from 2 studies; low-certainty evidence) or length of hospital stay (MD 0.1 respectively 0.2, 95% CI -0.68 to 1.08; data from 2 studies; moderate-certainty evidence). One trial (396 participants) compared MBP+oAB versus nBP. The evidence is uncertain about the effect of MBP+oAB on the incidence of SSI as well as mortality (RR 0.63, 95% CI 0.33 to 1.23 respectively RR 0.20, 95% CI 0.01 to 4.22; low-certainty evidence), while no effect on the risk of anastomotic leakages (RR 0.89, 95% CI 0.33 to 2.42; low-certainty evidence), the incidence of postoperative ileus (RR 1.18, 95% CI 0.77 to 1.81; low-certainty evidence) or the length of hospital stay (MD 0.1, 95% CI -0.8 to 1; low-certainty evidence) could be demonstrated.

Authors' conclusions: Based on moderate-certainty evidence, our results suggest that MBP+oAB is probably more effective than MBP alone in preventing postoperative complications. In particular, with respect to our primary outcomes, SSI and anastomotic leakage, a lower incidence was demonstrated using MBP+oAB. Whether oAB alone is actually equivalent to MBP+oAB, or leads to a reduction or increase in the risk of postoperative complications, cannot be clarified in light of the low- to very low-certainty evidence. Similarly, it remains unclear whether omitting preoperative bowel preparation leads to an increase in the risk of postoperative complications due to limited evidence. Additional RCTs, particularly on the comparisons of MBP+oAB versus oAB alone or nBP, are needed to assess the impact of oAB alone or nBP compared with MBP+oAB on postoperative complications and to improve confidence in the estimated effect. In addition, RCTs focusing on subgroups (e.g. in relation to type and location of colon resections) or reporting side effects of the intervention are needed to determine the most effective approach of preoperative bowel preparation.

Trial registration: ClinicalTrials.gov NCT02618720 NCT04281667 NCT03042091 NCT03491540 NCT03563586 NCT03856671 NCT04931173 NCT04161599 NCT03663504.

PubMed Disclaimer

Conflict of interest statement

MW: Surgical resident at the University Hospital Bonn. This review is intended as a partial aspect of the evidence workup for a new guideline on perioperative medicine for gastrointestinal tumours. This guideline is being developed with the AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V.) and the German Guideline Program in Oncology, and is funded by the German Cancer Aid (see Sources of support).

IT: None.

SS: None.

JK: None.

JM: None.

TV: Scientific grant from the German Cancer Aid to create a guideline for 'Perioperative Management of Gastrointestinal Tumours (POMGAT)' (see Sources of support); publications in the field of perioperative medicine; head of the Colorectal Surgery and Proctology section at the University Hospital Bonn.

Figures

1
1
Figure 1: PRISMA flowchart
2
2
Comparison 1 (MBP+oAB vs. MBP): Funnel plot regarding the incidence of SSI
3
3
Comparison 1 (MBP+oAB vs. MBP): Funnel plot regarding the incidence of anastomotic leakage
4
4
Investigate sensitivity ‐ 1.1 SSI
5
5
Investigate sensitivity ‐ 1.4 Anastomotic leakage
6
6
Investigate sensitivity ‐ 1.5 Mortality
7
7
Investigate sensitivity ‐ 1.8 Incidence of postoperative ileus
8
8
Investigate sensitivity ‐ 1.9 Length of hospital stay
1.1
1.1. Analysis
Comparison 1: MBP+oAB vs. MBP, Outcome 1: SSI
1.2
1.2. Analysis
Comparison 1: MBP+oAB vs. MBP, Outcome 2: Incisional SSI
1.3
1.3. Analysis
Comparison 1: MBP+oAB vs. MBP, Outcome 3: Organ/space SSI
1.4
1.4. Analysis
Comparison 1: MBP+oAB vs. MBP, Outcome 4: Anastomotic leakage
1.5
1.5. Analysis
Comparison 1: MBP+oAB vs. MBP, Outcome 5: Mortality
1.6
1.6. Analysis
Comparison 1: MBP+oAB vs. MBP, Outcome 6: Mild postoperative complications according to Clavien‐Dindo(I + II)
1.7
1.7. Analysis
Comparison 1: MBP+oAB vs. MBP, Outcome 7: Severe postoperative complications according to Clavien‐Dindo (III + IV)
1.8
1.8. Analysis
Comparison 1: MBP+oAB vs. MBP, Outcome 8: Incidence of postoperative ileus
1.9
1.9. Analysis
Comparison 1: MBP+oAB vs. MBP, Outcome 9: Length of hospital stay
1.10
1.10. Analysis
Comparison 1: MBP+oAB vs. MBP, Outcome 10: Side effects of Intervention ‐ Nausea/Vometing
1.11
1.11. Analysis
Comparison 1: MBP+oAB vs. MBP, Outcome 11: Side effects of Intervention ‐ Abdominal pain
1.12
1.12. Analysis
Comparison 1: MBP+oAB vs. MBP, Outcome 12: C. difficile‐related diarrhoea
1.13
1.13. Analysis
Comparison 1: MBP+oAB vs. MBP, Outcome 13: SSI_Subgroup analysis regarding surgery indication
1.14
1.14. Analysis
Comparison 1: MBP+oAB vs. MBP, Outcome 14: SSI_Subgroup analysis regarding the type of surgery
1.15
1.15. Analysis
Comparison 1: MBP+oAB vs. MBP, Outcome 15: SSI_Subgroup analysis regarding the surgical approach
1.16
1.16. Analysis
Comparison 1: MBP+oAB vs. MBP, Outcome 16: SSI_Subgroup analysis regarding the duration of mechanical bowel preparation
1.17
1.17. Analysis
Comparison 1: MBP+oAB vs. MBP, Outcome 17: SSI_Subgroup analysis regarding the agent combination of oral antibiotics
1.18
1.18. Analysis
Comparison 1: MBP+oAB vs. MBP, Outcome 18: SSI_Subgroup analysis regarding the duration of intravenous antibiotic prophylaxis
2.1
2.1. Analysis
Comparison 2: MBP+oAB vs. oAB, Outcome 1: SSI
2.2
2.2. Analysis
Comparison 2: MBP+oAB vs. oAB, Outcome 2: Anastomotic leakage
2.3
2.3. Analysis
Comparison 2: MBP+oAB vs. oAB, Outcome 3: Mortality
2.4
2.4. Analysis
Comparison 2: MBP+oAB vs. oAB, Outcome 4: Incidence of postoperative ileus
3.1
3.1. Analysis
Comparison 3: MBP+oAB vs. nBP, Outcome 1: SSI
3.2
3.2. Analysis
Comparison 3: MBP+oAB vs. nBP, Outcome 2: Incisional SSI
3.3
3.3. Analysis
Comparison 3: MBP+oAB vs. nBP, Outcome 3: Organ/space SSI
3.4
3.4. Analysis
Comparison 3: MBP+oAB vs. nBP, Outcome 4: Anastomotic leakage
3.5
3.5. Analysis
Comparison 3: MBP+oAB vs. nBP, Outcome 5: Mortality
3.6
3.6. Analysis
Comparison 3: MBP+oAB vs. nBP, Outcome 6: Mild postoperative complications according to Clavien‐Dindo(I + II)
3.7
3.7. Analysis
Comparison 3: MBP+oAB vs. nBP, Outcome 7: Severe postoperative complications according to Clavien‐Dindo(III + IV)
3.8
3.8. Analysis
Comparison 3: MBP+oAB vs. nBP, Outcome 8: Incidence of postoperative ileus
3.9
3.9. Analysis
Comparison 3: MBP+oAB vs. nBP, Outcome 9: Length of hospital stay
3.10
3.10. Analysis
Comparison 3: MBP+oAB vs. nBP, Outcome 10: Side effects of Intervention
3.11
3.11. Analysis
Comparison 3: MBP+oAB vs. nBP, Outcome 11: C. difficile‐related diarrhoea
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Anjum 2017 {published data only}
    1. Anjum N, Ren J, Wang G, Li G, Wu X, Dong H, et al. A randomized control trial of preoperative oral antibiotics as adjunct therapy to systemic antibiotics for preventing surgical site infection in clean contaminated, contaminated, and dirty type of colorectal surgeries. Diseases of the Colon and Rectum 2017;60(12):1291–8. [DOI: 10.1097/DCR.0000000000000927] [PMID: ] - DOI - PubMed
Arezzo 2021 {published and unpublished data}
    1. Arezzo A, Mistrangelo M, Bonino MA, Salusso P, Forcignano E, Vettoretto N, et al. Oral neomycin and bacitracin are effective in preventing surgical site infections in elective colorectal surgery: a multicentre, randomized, parallel, single-blinded trial (COLORAL-1). Updates in Surgery 2021;73(5):1775–86. - PMC - PubMed
    1. Arezzo A. Primary data of the study [personal communication]. Email to: M Morino and A Arezzo 13 January 2022.
    1. NCT04438655. Prospective randomized clinical trial on oral and intravenous antibiotic prophylaxis in colorectal surgery (COLORAL1). clinicaltrials.gov/ct2/show/NCT04438655 (first received 19 June 2020).
Espin‐Basany 2005 {published data only}
    1. Espin-Basany E, Sanchez-Garcia JL, Lopez-Cano M, Lozoya-Trujillo R, Medarde-Ferrer M, Armadans-Gil L, et al. Prospective, randomised study on antibiotic prophylaxis in colorectal surgery. Is it really necessary to use oral antibiotics? International Journal of Colorectal Disease 2005;20(6):542–6. [DOI: 10.1007/s00384-004-0736-8] - DOI - PubMed
Hata 2016 {published data only}
    1. Goto S, Hasegawa S, Hata H, Yamaguchi T, Hida K, Nishitai R, et al. Differences in surgical site infection between laparoscopic colon and rectal surgeries: sub-analysis of a multicenter randomized controlled trial (Japan-multinational trial organization PREV 07-01). International Journal of Colorectal Disease 2016;31(11):1775–84. [DOI: 10.1007/s00384-016-2643-1] [PMID: ] - DOI - PubMed
    1. Hata H, Yamaguchi T, Hasegawa S, Nomura A, Hida K, Nishitai R, et al. Oral and parenteral versus parenteral antibiotic prophylaxis in elective laparoscopic colorectal surgery (JMTO PREV 07-01) a phase 3, multicenter, open-label, randomized trial. Annals of Surgery 2016;263(6):1085–91. - PubMed
    1. NCT00508690. Trial of antibiotic prophylaxis in elective laparoscopic colorectal surgery: oral and systemic versus systemic antibiotics. clinicaltrials.gov/ct2/show/NCT00508690 (first received 30 July 2007).
Horie 2007 {published data only}
    1. Horie T. Randomized controlled trial on the necessity of chemical cleaning as preoperative preparation for colorectal cancer surgery. Dokkyo Journal of Medical Sciences 2007;34(3):205-12.
Ikeda 2016 {published and unpublished data}
    1. Ikeda A, Konishi T, Ueno M, Fukunaga Y, Nagayama S, Fujimoto Y, et al. Randomized clinical trial of oral and intravenous versus intravenous antibiotic prophylaxis for laparoscopic colorectal resection. British Journal of Surgery 2016;103(12):1608–15. - PubMed
    1. Konishi T. Primary data of the study [personal communication]. Email to: T Konishi 12 January 2022.
Ishida 2001 {published data only}
    1. Ishida H, Yokoyama M, Nakada H, Inokuma S, Hashimoto D. Impact of oral antimicrobial prophylaxis on surgical site infection and methicillin-resistantstaphylococcus aureus infection after elective colorectal surgery. Results of a prospective randomized trial. Surgery Today 2001;31(11):979–83. - PubMed
Kobayashi 2007 {published data only}
    1. Kobayashi M, Mohri Y, Tonouchi H, Miki C, Nakai K, Kusunoki M. Randomized clinical trial comparing intravenous antimicrobial prophylaxis alone with oral and intravenous antimicrobial prophylaxis for the prevention of a surgical site infection in colorectal cancer surgery. Surgery Today 2007;37(5):383–8. - PubMed
Koskenvuo 2019 {published data only}
    1. EudraCT 2015–004559–38. Bowel preparation before bowel resection. clinicaltrialsregister.eu/ctr-search/search?query=2015-004559-38 (first received 11 December 2015).
    1. Koskenvuo L, Lehtonen T, Koskensalo S, Rasilainen S, Klintrup K, Ehrlich A, et al. Mechanical and oral antibiotic bowel preparation versus no bowel preparation for elective colectomy (MOBILE): a multicentre, randomised, parallel, single-blinded trial. Lancet 2019;394(10201):840–8. - PubMed
    1. NCT02652637. MOBILE Trial. Mechanical and oral antibiotic bowel preparation versus no bowel preparatIon for elective colectomy - a multicenter, prospective, randomized, controlled trial. clinicaltrials.gov/ct2/show/NCT02652637 (first received 12 January 2016).
Lau 1988 {published data only}
    1. Lau WY, Chu KW, Poon GP, Ho KK. Prophylactic antibiotics in elective colorectal surgery. British Journal of Surgery 1988;75(8):782–5. [DOI: 10.1002/bjs.1800750819] [PMID: ] - DOI - PubMed
Lazorthes 1982 {published data only}
    1. Lazorthes F, Legrand G, Monrozies X, Fretigny E, Pugnet G, Cordova JA, et al. Comparison between oral and systemic antibiotics and their combined use for the prevention of complications in colorectal surgery. Diseases of the Colon & Rectum 1982;25(4):309-11. - PubMed
Lewis 2002 {published data only}
    1. Lewis RT. Oral versus systemic antibiotic prophylaxis in elective colon surgery: a randomized study and meta-analysis send a message from the 1990s. Canadian Journal of Surgery 2002;45(3):173–80. [PMID: ] - PMC - PubMed
Oshima 2013 {published data only}
    1. Oshima T, Takesue Y, Ikeuchi H, Matsuoka H, Nakajima K, Uchino M, et al. Preoperative oral antibiotics and intravenous antimicrobial prophylaxis reduce the incidence of surgical site infections in patients with ulcerative colitis undergoing IPAA. Diseases of the Colon and Rectum 2013;56(10):1149–55. - PubMed
Papp 2021 {published data only}
    1. EudraCT 2015-005614-30. SOAP antibiotic prophylaxis trial systemic versus combined systemic and oral antibiotic prophylaxis in elective colorectal surgery. clinicaltrialsregister.eu/ctr-search/search?query=2015-005614-30 (first received 07 July 2016).
    1. Papp G, Saftics G, Szabo BE, BaracsJ, Vereczkei A, Kollar D, et al. Systemic versus oral and systemic antibiotic prophylaxis (SOAP) study in colorectal surgery: prospective randomized multicentre trial. British Journal of Surgery 2021;108(3):271–6. - PubMed
Ram 2005 {published data only (unpublished sought but not used)}
    1. Ram E, Sherman Y, Weil R, Vishne T, Kravarusic D, Dreznik Z. Is mechanical bowel preparation mandatory for elective colon surgery? A prospective randomized study. Archives of Surgery 2005;140(3):285–8. - PubMed
Rybakov 2021 {published data only}
    1. NCT03436719. Antibiotic prophylaxis in rectal cancer surgery: oral with intravenous versus intravenous antibiotics. clinicaltrials.gov/ct2/show/NCT03436719 (first received 19 February 2018).
    1. Rybakov E, Nagudov M, Sukhina M, Shelygin Y. Impact of oral antibiotic prophylaxis on surgical site infection after rectal surgery: results of randomized trial. International Journal of Colorectal Disease 2021;36(2):323–30. [DOI: 10.1007/s00384-020-03746-0] [PMID: ] - DOI - PubMed
Sadahiro 2014 {published data only}
    1. Sadahiro S, Suzuki T, Tanaka A, Okada K, Kamata H, Ozaki T, et al. Comparison between oral antibiotics and probiotics as bowel preparation for elective colon cancer surgery to prevent infection: prospective randomized trial. Surgery (United States) 2014;155(3):493-503. - PubMed
Suzuki 2020 {published data only}
    1. Suzuki T, Sadahiro S, Tanaka A, Okada K, Saito G, Miyakita H, et al. Usefulness of preoperative mechanical bowel preparation in patients with colon cancer who undergo elective surgery: a prospective randomized trial using oral antibiotics. Digestive Surgery 2020;37(3):192-8. - PubMed
Takesue 2000 {published data only}
    1. Takesue Y, Yokoyama T, Akagi S, Ohge H, Murakami Y, Sakashita Y, et al. A brief course of colon preparation with oral antibiotics. Surgery Today 2000;30(2):112-6. - PubMed
Uchino 2019 {published and unpublished data}
    1. Uchino M, Ikeuchi H, Bando T, Chohno T, Sasaki H, Horio Y, et al. Efficacy of pre-operative oral antibiotic prophylaxis for the prevention of wound infections in patients with crohn's disease. Annals of Surgery 2019;269(3):420–6. [DOI: 10.1097/SLA.0000000000002567] [PMID: ] - DOI - PubMed
    1. Uchino M. Primary data of the study [personal communication]. Email to: M Uchino 14 January 2022.
Zmora 2003 {published data only}
    1. Zmora O, Mahajna A, Bar-Zakai B, Rosin D, Hershko D, Shabtai M, et al. Colon and rectal surgery without mechanical bowel preparation: a randomized prospective trial. Annals of Surgery 2003;237(3):363–7. [DOI: 10.1097/01.SLA.0000055222.90581.59] [PMID: ] - DOI - PMC - PubMed

References to studies excluded from this review

Alverdy 2019 {published data only}
    1. Alverdy JC, Shogan D. Preparing the bowel for surgery: rethinking the strategy. Nature Reviews Gastroenterology & Hepatology 2019;16(12):708-9. - PMC - PubMed
Anthony 2011 {published data only}
    1. Anthony T, Murray BW, Sum-Ping JT, Lenkovsky F, Vornik VD, Parker BJ, et al. Evaluating an evidence-based bundle for preventing surgical site infection: a randomized trial. Archives of Surgery 2011;146(3):263-9. - PubMed
    1. Dallas VA Medical Center. Minimization of surgical site infections for pts undergoing colorectal surgery. ClinicalTrials.gov. [CLINICALTRIALS.GOV: NCT00953784]
Barker 1971 {published data only}
    1. Barker K, Graham NG, Mason MC, De Dombal FT, Goligher JC. The relative significance of preoperative oral antibiotics, mechanical bowel preparation, and preoperative peritoneal contamination in the avoidance of sepsis after radical surgery for ulcerative colitis and Crohn's disease of the large bowel. British Journal of Surgery 1971;58(4):270-3. - PubMed
Champault 1981 {published data only}
    1. Champault G, Adloff M, Alexandre JH, Arnaud JP, Boutelier P, Chevrel JP, et al. Pre-operative preparation of the colon: a controlled prospective multicentre study in 215 patients (author's transl). Journal de Chirurgie 1981;118(11):677-84. - PubMed
Clarke 1977 {published data only}
    1. Clarke JS, Condon RE, Bartlett JG, Gorbach SL, Nichols RL, Ochi S. Preoperative oral antibiotics reduce septic complications of colon operations: results of prospective, randomized, double-blind clinical study. Annals of Surgery 1977;186(3):251. - PMC - PubMed
COLONPREP {published data only}
    1. Assistance Publique - Hôpitaux de Paris. Mechanical bowel preparation and oral antibiotics before colon cancer surgery (COLONPREP). clinicaltrials.gov. [CLINICALTRIALS.GOV: NCT03475680]
Condon 1979 {published data only}
    1. Condon RE, Bartlett JG, Nichols RL, Schulte WJ, Gorbach SL, Ochi S. Preoperative prophylactic cephalothin fails to control septic complications of colorectal operations: results of controlled clinical trial: a Veterans Administration cooperative study. American Journal of Surgery 1979;137(1):68-74. - PubMed
Contant 2007 {published data only}
    1. Contant CM, Hop WC, van't Sant HP, Oostvogel HJ, Smeets HJ, Stassen LP, et al. Mechanical bowel preparation for elective colorectal surgery: a multicentre randomised trial. Lancet 2007;370(9605):2112-7. - PubMed
Coppa 1983 {published data only}
    1. Coppa GF, Eng K, Gouge TH, Ranson JH, Localio SA. Parenteral and oral antibiotics in elective colon and rectal surgery: a prospective, randomized trial. American Journal of Surgery 1983;145(1):62-5. - PubMed
Eisenberg 1981 {published data only}
    1. Eisenberg Henry W. Cefamandole preparation for colonic surgery. Diseases of the Colon & Rectum 1981;24(8):610-2. - PubMed
Emir 2012 {published data only}
    1. Emir S, Kavlakoglu B, Sozen S, Yazar MF, Ozkan Z. Mechanical bowel preparation before elective colorectal surgery: is it necessary? A prospective, randomized and controlled study. Turkish Journal of Surgery 2012;28(2):84.
Flückiger 1980 {published data only}
    1. Flückiger M, Berger J, Casey P, Aeberhard P. Antibiotic preparation of the colon or preoperative parenteral prophylaxis in colon surgery. A randomized study. Helvetica Chirurgica Acta 1980;47(5):659-62. - PubMed
Güenaga 2011 {published data only}
    1. Güenaga KF, Matos D, Wille‐Jørgensen P. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database of Systematic Reviews 2011, Issue 9. Art. No: CD001544. [DOI: 10.1002/14651858.CD001544.pub3] - DOI - PMC - PubMed
Hjalmarsson 2015 {published data only}
    1. Hjalmarsson C, Karlberg J, Törnqvist P, Arbman G, Frisk B, Modin M, et al. Orally administered trimethoprim-sulfamethoxazole and metronidazole as infection prophylaxis in elective colorectal surgery. Surgical Infections 2015;16(5):604-10. - PubMed
Ishibashi 2009 {published data only}
    1. Ishibashi K, Kuwabara K, Ishiguro T, Ohsawa T, Okada N, Miyazaki T, et al. Short-term intravenous antimicrobial prophylaxis in combination with preoperative oral antibiotics on surgical site infection and methicillin-resistant staphylococcus aureus infection in elective colon cancer surgery: results of a prospective randomized trial. Surgery Today 2009;39(12):1032-9. - PubMed
Jagelman 1985 {published data only}
    1. Jagelman DG, Fazio VW, Lavery IC, Weakley FL. A prospective, randomized, double-blind study of 10% mannitol mechanical bowel preparation combined with oral neomycin and short-term, perioperative, intravenous flagyl as prophylaxis in elective colorectal resections.. Surgery 1985;98(5):861-5. - PubMed
Kolovrat 2012 {published data only}
    1. Kolovrat M, Busic Z, Lovric Z, Amic F, Cavka V, Boras Z, et al. Mechanical bowel preparation in colorectal surgery. Collegium antropologicum 2012;36(4):1343-6. - PubMed
Mehdorn 2021 {published data only}
    1. Mehdorn M, Lübbert C, Chaberny IF, Gockel I, Jansen-Winkeln B. Mechanical plus oral bowel preparation with paromomycine and metronidazole reduces infectious complications in elective colorectal surgery: a matched case-control study. International Journal of Colorectal Disease 2021;36(9):1839-49. - PMC - PubMed
Mendes Da Costa 1977 {published data only}
    1. Mendes Da Costa P, Klastersky J, Gerard A. Controlled study of oral administration of antibiotics in the preparation of digestive surgery [Etude controlee de l'administration orale d'antibiotiques comme preparation a la chirurgie digestive]. Acta chirurgica Belgica (Ed. bilingue) 1977;76(5):475-80. - PubMed
Mulder 2020 {published and unpublished data}
    1. Mulder T, Kluytmans-van den Bergh M, Vlaminckx B, Roos D, Smet AM, Vos Tot Nederveen Cappel R, et al. Prevention of severe infectious complications after colorectal surgery using oral non-absorbable antimicrobial prophylaxis: results of a multicenter randomized placebo-controlled clinical trial. Antimicrobial Resistance and Infection Control 2020;9(1):84-95. [DOI: 10.1186/s13756-020-00745-2] [PMID: ] - DOI - PMC - PubMed
Playforth 1988 {published data only}
    1. Playforth MJ, Smith GM, Evans M, Pollock AV. Antimicrobial bowel preparation. Diseases of the Colon & Rectum 1988;31(2):90-3. - PubMed
Reddy 2007 {published data only}
    1. Reddy BS, Macfie J, Gatt M, Larsen CN, Jensen SS, Leser TD. Randomized clinical trial of effect of synbiotics, neomycin and mechanical bowel preparation on intestinal barrier function in patients undergoing colectomy. Journal of British Surgery 2007;94(5):546-54. - PubMed
Schardey 2020 {published data only}
    1. Schardey HM, Wirth U, Strauss T, Kasparek MS, Schneider D, Jauch KW. Prevention of anastomotic leak in rectal cancer surgery with local antibiotic decontamination: a prospective, randomized, double-blind, placebo-controlled single center trial. International Journal of Colorectal Disease 2020;35(5):847-57. - PubMed
Tajima 2016 {published data only}
    1. Tajima Y, Ishida H, Yamamoto A, Chika N, Onozawa H, Matsuzawa T, et al. Comparison of the risk of surgical site infection and feasibility of surgery between sennoside versus polyethylene glycol as a mechanical bowel preparation of elective colon cancer surgery: a randomized controlled trial. Surgery Today 2016;46(6):735-40. - PubMed
Takesue 2009 {published data only}
    1. Takesue Y, Hirata A, Kobayashi M, Yamagishi D, Matsuoka H, Tanaka K. Bowel preparation with oral antibiotics for the surgery in patients with ulcerative colitis (UC) and colorectal cancer (CRC): prospective, randomized study. Surgical Infections 2009;10:223-4.
Taylor 1994 {published data only}
    1. Taylor TW, Lindsay G. Selective decontamination of the colon before elective colorectal surgery. World Journal of Surgery 1994;18(6):926-31. - PubMed
Thalheimer 2008 {published data only}
    1. Thalheimer A, Germer CT. Mechanical bowel preparation before colorectal surgery? Digestive Surgery 2008;25(5):328. - PubMed
Vadhwana 2020 {published data only}
    1. Vadhwana B, Pouzi A, Surjus Kaneta G, Reid V, Claxton D, Pyne L, et al. Preoperative oral antibiotic bowel preparation in elective resectional colorectal surgery reduces rates of surgical site infections: a single-centre experience with a cost-effectiveness analysis. Annals of The Royal College of Surgeons of England 2020;102(2):133-40. - PMC - PubMed
Wolff 1988 {published data only}
    1. Wolff BG, Beart RW, Dozois RR, Pemberton JH, Zinsmeister AR, Ready RL, et al. A new bowel preparation for elective colon and rectal surgery: a prospective, randomized clinical trial. Archives of Surgery 1988;123(7):895-900. - PubMed
Yabata 1997 {published data only}
    1. Yabata E, Okabe S, Endo M. A prospective, randomized clinical trial of preoperative bowel preparation for elective colorectal surgery-comparison among oral, systemic, and intraoperative luminal antibacterial preparations. Journal of Medical and Dental Sciences 1997;44(4):75-80. - PubMed

References to studies awaiting assessment

Abis 2019 {published and unpublished data}
    1. Abis GS, Stockmann HB, Bonjer HJ, Veenendaal N, Doorn-Schepens ML, Budding AE, et al. Randomized clinical trial of selective decontamination of the digestive tract in elective colorectal cancer surgery (SELECT trial). British Journal of Surgery 2019;106(4):355–63. [DOI: 10.1002/bjs.11117] [PMID: ] - DOI - PubMed

References to ongoing studies

COMBINE {unpublished data only}2015‐002559‐84
    1. Vignaud M, Paugam-Burtz C, Garot M, Jaber S, Slim K, Panis Y, et al. Comparison of intravenous versus combined oral and intravenous antimicrobial prophylaxis (COMBINE) for the prevention of surgical site infection in elective colorectal surgery: study protocol for a multicentre, double-blind, randomised controlled clinical trial. BMJ Open 2018;8(4):e020254. - PMC - PubMed
CTRI/2018/07/014938 {published data only}CTRI/2018/07/014938
    1. CTRI/2018/07/014938. Role of oral antibiotics in reducing the chance of infection after operations for cancer of the rectum [Role of combined oral antibiotic and mechanical bowel preparation in reducing incidence of surgical site infections in comparison to only mechanical bowel preparation in patients undergoing elective resection for rectal cancer at a tertiary care centre in India: a randomized control trial]. ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=25532 (first received 18 July 2018).
EUCTR2019‐002002‐43‐ES {published data only}EUCTR2019‐002002‐43‐ES
    1. Unidad de Investigación Clínica. Phase IV, unicentric, randomized and open study to confirm the decrease of the incidence of the surgical site infection after elective right hemicolectomy with anterographic mechanical preparation associated with oral and intravenous antibiotic therapy versus oral and intravenous antibiotic and versus only intravenous antibiotic. trialsearch.who.int/Trial2.aspx?TrialID=EUCTR2019-002002-43-ES (first received 21 October 2019).
KCT0004822 {published data only}KCT0004822
    1. KCT0004822. Infectious surgical site complications after oral antibiotic bowel preparation for minimally-invasive rectal cancer surgery [Infectious surgical site Complications after Oral antibiotic Bowel preparation for minimally-invasive Rectal cAncer surgery (COBRA) – multicenter prospective randomized controlled trial]. trialsearch.who.int/?TrialID=KCT0004822 (first received 12 March 2020).
MECCLANT –C and –R Trials {published data only}2016‐000254‐352016‐001404‐32
    1. Xynos E, Gouvas N, Agalianos C, Balogiannis I, Christodoulakis M, Korkolis D, et al. Preparation with mechanical bowel cleansing or/and oral antibiotics or nothing for elective colorectal surgery: two-two-arm multicentre randomised controlled studies (MECCLANT –C and –R trials). Journal of Clinical Trials 2017;7(2):1233-46. [DOI: ]
MOBILE2 {published data only}
    1. Koskenvuo L, Lunkka P, Varpe P, Hyöty M, Satokari R, Haapamäki C, et al. Mechanical bowel preparation and oral antibiotics versus mechanical bowel preparation only prior rectal surgery (MOBILE2): a multicentre, double-blinded, randomised controlled trial-study protocol. BMJ Open 2021;11(7):e051269. [DOI: 10.1136/bmjopen-2021-051269] [PMID: ] - DOI - PMC - PubMed
NCT03042091 {published data only}
    1. NCT03042091. Neomycin and metronidazole hydrochloride with or without polyethylene glycol in reducing infection in patients undergoing elective colorectal surgery. clinicaltrials.gov/ct2/show/record/NCT03042091 (first received 3 February 2017).
NCT03491540 {unpublished data only}
    1. NCT03491540. Mechanical bowel preparation and oral antibiotics before rectal cancer surgery (PREPACOL2). clinicaltrials.gov/ct2/show/record/NCT03491540 (first received 4 October 2021).
NCT03563586 {unpublished data only}
    1. NCT03563586. Mechanical bowel preparation with or without oral antibiotics for colorectal cancer surgery (MECCA). clinicaltrials.gov/ct2/show/study/NCT03563586 (first received 20 June 2018).
NCT03856671 {published data only}
    1. NCT03856671. Prophylatic effect preoperative antibiotics with mechanical bowel preparation in SSIs. clinicaltrials.gov/ct2/show/study/NCT03856671 (first received 27 February 2019).
NCT04931173 {published data only}
    1. NCT04931173. Mechanical bowel prep randomized study. clinicaltrials.gov/ct2/show/study/NCT04931173 (first received 23 July 2021).
ORALEV2 {published data only}
    1. Pellino G, Solís-Peña A, Kraft M, Huguet BM, Espín-Basany E. Preoperative oral antibiotics with versus without mechanical bowel preparation to reduce surgical site infections following colonic resection: Protocol for an international randomized controlled trial (ORALEV2). Colorectal Disease: the official Journal of the Association of Coloproctology of Great Britain and Ireland 2021;23(8):2173–81. [DOI: 10.1111/codi.15681] - DOI - PubMed
Panaiotti 2020 {published data only}
    1. Panaiotti L, Olkina A, Petrov A, Lankov T, Karachun A. Mechanical bowel preparation with oral antibiotics vs no preparation before elective colon resection for colon cancer. European Journal of Surgical Oncology 2020;46:e92. [DOI: 10.1016/j.ejso.2019.11.223] - DOI
REaCT‐NSQIP {unpublished data only}
    1. Apte SS, Moloo H, Jeong A, Liu M, Vandemeer L, Suh K, et al. Prospective randomised controlled trial using the rethinking clinical trials (REaCT) platform and national surgical quality improvement program (NSQIP) to compare no preparation versus preoperative oral antibiotics alone for surgical site infection rates in elective colon surgery: a protocol. BMJ Open 2020;10(7):e036866. [DOI: 10.1136/bmjopen-2020-036866] [PMID: ] - DOI - PMC - PubMed
Tagliaferri 2020 {published and unpublished data}
    1. Tagliaferri AR, Kucejko R, Costanzo CM, Phillips B. Combined mechanical and oral antibiotic bowel preparation versus oral antibiotics alone for the reduction of surgical site infection following elective colorectal resection: Interim analysis. Diseases of the Colon and Rectum 2020;63(6):383.

Additional references

Anjum 2017
    1. Anjum N, Ren J, Wang G, Li G, Wu X, Dong H, et al. A randomized control trial of preoperative oral antibiotics as adjunct therapy to systemic antibiotics for preventing surgical site infection in clean contaminated, contaminated, and dirty type of colorectal surgeries. Diseases of the Colon & Rectum 2017;12:1291–8. [DOI: 10.1097/DCR.0000000000000927] - DOI - PubMed
Beck 2020
    1. Beck C, Weber K, Brunner M, Agaimy A, Semrau S, Grützmann R, et al. The influence of postoperative complications on long-term prognosis in patients with colorectal carcinoma. International Journal of Colorectal Disease 2020;6:1055–66. [DOI: 10.1007/s00384-020-03557-3] - DOI - PMC - PubMed
Buia 2019
    1. Buia A, Post S, Buhr HJ, Hanisch E. Bowel preparation for elective colorectal surgery in Germany 2017: results of a survey among members of the German Society of General and Visceral Surgery [Darmvorbereitung bei elektiven kolorektalen Resektionen in Deutschland 2017: Ergebnisse einer Umfrage unter den Mitgliedern der DGAV]. Der Chirurg 2019;90(7):564–9. [DOI: 10.1007/s00104-018-0773-4] - DOI - PubMed
Clavien 2009
    1. Clavien PA, Barkun J, Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Annals of Surgery 2009;250(2):187-96. [DOI: 10.1097/SLA.0b013e3181b13ca2] - DOI - PubMed
Deeks 2021
    1. Deeks JJ, Higgins JP, Altman DG, editor(s). Chapter 10: Analysing data and undertaking meta-analyses. In: Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 6.2 (updated February 2021). Cochrane, 2021. Available from training.cochrane.org/handbook.
Devane 2017
    1. Devane LA, Proud D, O'Connell PR, Panis Y. A European survey of bowel preparation in colorectal surgery. Colorectal Disease 2017;19(11):402-6. [DOI: 10.1111/codi.13905] - DOI - PubMed
GRADEpro GDT [Computer program]
    1. GRADEpro GDT. Version accessed 20 December 2021. Hamilton (ON): McMaster University (developed by Evidence Prime), 2021. Available at gradepro.org.
Gustafsson 2019
    1. Gustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines N, Francis N, et al. Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations: 2018. World Journal of Surgery 2019;43(3):659-95. - PubMed
Higgins 2021
    1. Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 6.2 (updated February 2021). Cochrane, 2021. Available from training.cochrane.org/handbook. - PMC - PubMed
ISOS 2016
    1. International Surgical Outcomes Study group. Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries. British Journal of Anaesthesia 2016;117(5):601–9. [DOI: 10.1093/bja/aew316] - DOI - PMC - PubMed
Klinger 2019
    1. Klinger AL, Green H, Monlezun DJ, Beck D, Kann B, Vargas HD, et al. The role of bowel preparation in colorectal surgery: results of the 2012-2015 ACS-NSQIP data. Annals of Surgery 2019;269(4):671–7. [DOI: 10.1097/SLA.0000000000002568] - DOI - PubMed
Kuhry 2008
    1. Kuhry E, Schwenk WF, Gaupset R, Romild U, Bonjer HJ. Long-term results of laparoscopic colorectal cancer resection. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No: CD003432. [DOI: 10.1002/14651858.CD003432.pub2] - DOI - PMC - PubMed
Kulu 2015
    1. Kulu Y, Büchler MW, Ulrich A. Perioperative complications of the lower gastrointestinal tract. Prevention, recognition and treatment [Perioperative Komplikationen des unteren Gastrointestinaltraktes]. Der Chirurg 2015;86(4):311-8. [DOI: 10.1007/s00104-014-2848-1] - DOI - PubMed
Kumar 2013
    1. Kumar AS, Kelleher DC, Sigle GW. Bowel preparation before elective surgery. Clinics in Colon and Rectal Surgery 2013;26(3):146–52. [DOI: 10.1055/s-0033-1351129] - DOI - PMC - PubMed
Ling 2019
    1. Ling ML, Apisarnthanarak A, Abbas A, Morikane K, Lee KY, Warrier A, et al. APSIC guidelines for the prevention of surgical site infections. Antimicrobial Resistance & Infection Control 2019;8:174. [DOI: 10.1186/s13756-019-0638-8] [PMID: ] - DOI - PMC - PubMed
Lynch 2016
    1. Lynch SV, Pedersen O. The human intestinal microbiome in health and disease. New England Journal of Medicine 2016;375(24):2369–79. [DOI: 10.1056/NEJMra1600266] - DOI - PubMed
Markell 2010
    1. Markell KW, Hunt BM, Charron PD, Kratz RJ, Nelson J, Isler JT, et al. Prophylaxis and management of wound infections after elective colorectal surgery: a survey of the American Society of Colon and Rectal Surgeons membership. Journal of Gastrointestinal Surgery 2010;14(7):1090–8. [DOI: 10.1007/s11605-010-1218-7] - DOI - PubMed
McSorley 2018
    1. McSorley ST, Steele CW, McMahon AJ. Meta-analysis of oral antibiotics, in combination with preoperative intravenous antibiotics and mechanical bowel preparation the day before surgery, compared with intravenous antibiotics and mechanical bowel preparation alone to reduce surgical-site infections in elective colorectal surgery. BJS Open 2018;2(4):185–94. [DOI: 10.1002/bjs5.68] - DOI - PMC - PubMed
Migaly 2019
    1. Migaly J, Bafford AC, Francone TD, Gaertner WB, Eskicioglu C, Bordeianou L, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Use of Bowel Preparation in Elective Colon and Rectal Surgery. Diseases of the Colon & Rectum 2019;62(1):3-8. [DOI: 10.1097/DCR.0000000000001238] - DOI - PubMed
Nachiappan 2016
    1. Nachiappan S, Askari A, Mamidanna R, Munasinghe A, Currie A, Stebbing J, et al. Initiation of adjuvant chemotherapy within 8 weeks of elective colorectal resection improves overall survival regardless of reoperation. Colorectal Disease 2016;18(11):1041–9. [DOI: 10.1111/codi.13308] - DOI - PubMed
Nelson 2014
    1. Nelson RL, Gladman E, Barbateskovic M. Antimicrobial prophylaxis for colorectal surgery. Cochrane Database of Systematic Reviews 2014, Issue 5. Art. No: CD001181. [DOI: 10.1002/14651858.CD001181.pub4] - DOI - PMC - PubMed
Nelson 2020
    1. Nelson RL, Hassan M, Grant MD. Antibiotic prophylaxis in colorectal surgery: are oral, intravenous or both best and is mechanical bowel preparation necessary? Techniques in Coloproctology 2020;24(12):1233–46. [DOI: 10.1007/s10151-020-02301-x] [PMID: ] - DOI - PubMed
NICE 2019
    1. National Institute for Health and Care Excellence. Surgical site infections: prevention and treatment. www.nice.org.uk/guidance/ng125 (accessed 20 December 2021). [ISBN: 978-1-4731-3394-5]
Review Manager 2020 [Computer program]
    1. Review Manager (RevMan). Version 5.4. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2020.
RevMan Web 2020 [Computer program]
    1. Review Manager Web (RevMan Web). Version 1.22.0. The Cochrane Collaboration, 2020. Available at revman.cochrane.org.
Rollins 2019
    1. Rollins KE, Javanmard-Emamghissi H, Acheson AG, Lobo DN. The role of oral antibiotic preparation in elective colorectal surgery: a meta-analysis. Annals of Surgery 2019;270(1):43–58. [DOI: 10.1097/SLA.0000000000003145] - DOI - PMC - PubMed
Schardey 2017
    1. Schardey HM, Rogers S, Schopf SK, Ahnen T, Wirth U. Are gut bacteria associated with the development of anastomotic leaks? [Sind Darmbakterien an der Entstehung der Anastomoseninsuffizienz beteiligt?: Eine Übersicht über experimentelle und klinische Arbeiten]. Coloproctology 2017;39:94–100. [DOI: 10.1007/s00053-016-0136-x] - DOI
Schünemann 2013
    1. Schünemann H, Brożek J, Guyatt G, Oxman A, editor(s). Handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach (updated October 2013). GRADE Working Group, 2013. Available from gdt.guidelinedevelopment.org/app/handbook/handbook.html.
Schünemann 2021
    1. Schünemann HJ, Higgins JP, Vist GE, Glasziou P, Akl EA, Skoetz N, et al. Chapter 14: Completing ‘Summary of findings’ tables and grading the certainty of the evidence. In: Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 6.2 (updated February 2021). Cochrane, 2021. Available from training.cochrane.org/handbook.
Shogan 2015
    1. Shogan BD, Belogortseva N, Luong PM, Zaborin A, Lax S, Bethel C, et al. Collagen degradation and MMP9 activation by Enterococcus faecalis contributes to intestinal anastomotic leak. Science Translational Medicine 2015;7(286):286ra68. [DOI: 10.1126/scitranslmed.3010658] [PMID: ] - DOI - PMC - PubMed
Solla 1990
    1. Solla JA, Rothenberger DA. Preoperative bowel preparation. A survey of colon and rectal surgeons. Diseases of the Colon & Rectum 1990;33(2):154–9. [DOI: 10.1007/BF02055549] [PMID: ] - DOI - PubMed
Spanjersberg 2011
    1. Spanjersberg WR, Reurings J, Keus F, Laarhoven C. Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database of Systematic Reviews 2011, Issue 2. Art. No: CD007635. [DOI: 10.1002/14651858.CD007635.pub2] - DOI - PubMed
Sterne 2019
    1. Sterne JA, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019;366:4898. [DOI: 10.1136/bmj.l4898] [PMID: ] - DOI - PubMed
Toh 2018
    1. Toh JW, Phan K, Hitos K, Pathma-Nathan N, El-Khoury T, Richardson AJ, et al. Association of mechanical bowel preparation and oral antibiotics before elective colorectal surgery with surgical site infection: a network meta-analysis. JAMA Network Open 2018;1(6):e183226. [DOI: 10.1001/jamanetworkopen.2018.3226] [PMID: ] - DOI - PMC - PubMed
Walker 2004
    1. Walker KG, Bell SW, Rickard MJ, Mehanna D, Dent OF, Chapuis PH, et al. Anastomotic leakage is predictive of diminished survival after potentially curative resection for colorectal cancer. Annals of Surgery 2004;240(2):255–9. [DOI: 10.1097/01.sla.0000133186.81222.08] [PMID: ] - DOI - PMC - PubMed
Weidenhagen 2007
    1. Weidenhagen R, Spelsberg F, Strauss T, Jauch K-W. Anastomotic dehiscence in colorectal surgery [Anastomoseninsuffizienz in der kolorektalen Chirurgie]. Viszeralchirurgie 2007;42:165–72. [DOI: 10.1055/s-2007-960720] - DOI
WHO 2018
    1. World Health Organization. Global guidelines for the prevention of surgical site infection. www.ncbi.nlm.nih.gov/books/NBK536404/ (accessed 20 December 2021).
Young 2012
    1. Young H, Knepper B, Moore EE, Johnson JL, Mehler P, Price CS. Surgical site infection after colon surgery: National Healthcare Safety Network risk factors and modeled rates compared with published risk factors and rates. Journal of the American College of Surgeons 2012;214(5):852–9. [DOI: 10.1016/j.jamcollsurg.2012.01.041] - DOI - PubMed

References to other published versions of this review

Willis 2022
    1. Willis MA, Toews I, Meerpohl JJ, Vilz TO. Preoperative combined mechanical and oral antibiotic bowel preparation for preventing complications in elective colorectal surgery. Cochrane Database of Systematic Reviews 2022, Issue 1. Art. No: CD014909. [DOI: 10.1002/14651858.CD014909] - DOI - PMC - PubMed

Publication types

MeSH terms

Substances

Associated data