Aggressive bowel preparation does not enhance bacterial translocation, provided the mucosal barrier is not disrupted: a prospective, randomized study

Abstract

Purpose: Prospective, randomized studies have shown that bowel preparation may adversely affect infectious complications following colonic resections. However, very little is known about the effects of bacterial translocation on these infectious complications. The aim of this prospective, randomized study was to assess the effects of bowel preparation on bacterial translocation.

Methods: A total of 82 consecutive patients undergoing elective abdominal operations were randomly assigned to four groups: control (I; n = 20), mechanical (II; n = 21), mechanical plus oral metronidazole (III; n = 20), and polyethylene glycol preparation (IV; n = 21). Patients with intra-abdominal infection, those receiving preoperative antibiotics for any reason, and those having lower gastrointestinal tract disease were excluded from the study. Peritoneal swab, ileocecal and pericolic mesenteric lymph nodes, liver wedge biopsy, portal venous blood, and peripheral blood samples were taken for culture. Patients were followed up for postoperative infectious complications. Groups were matched according to age, gender, body surface area, and Acute Physiology and Chronic Health Evaluation II scores.

Results: Bacterial translocation was identified by a positive culture in one patient in Group I, two in Group II, one in Group III, and three in Group IV, respectively. Differences in number of positive cultures among the groups were not statistically significant. Nine patients had major infectious complications. Only two had bacterial translocation, and the same micro-organisms grew in both patients, in one at the wound site and in the other at the cyst abscess.

Conclusion: This study demonstrated that mechanical bowel preparation does not enhance the spontaneous occurrence of bacterial translocation in patients without any clinical signs of lower gastrointestinal tract disease.