Mechanical preparation of the large bowel for elective surgery. Comparison of whole-gut lavage with the conventional enema and purgative technique.

In this prospective, randomized study, 121 elective colorectal surgery patients had whole-gut lavage (n = 67) or enemas and purgatives (n = 54). Patient characteristics were well matched. Intravenous metronidazole and tobramycin were administered preoperatively initially in 53 patients, with the remaining 68 patients receiving the drugs perioperatively. Bowel preparation was satisfactory (minimal or no contents remaining) in 92.8 percent of patients with whole-gut lavage and 92.6 percent with enemas and purgatives (p = 0.72). Nasogastric tube insertion was poorly tolerated by 39 percent of the patients receiving whole-gut lavage, and enema tube insertion by 23 percent with enemas and purgatives. Fluid infusion tolerance was similar with both techniques. Abdominal wound sepsis occurred in 22 patients (18.8 percent), being unrelated to mechanical preparation or antimicrobial prophylaxis (p = 0.19). Colostomy closure was associated with a 42.8 percent sepsis rate. Excluding this group, wound sepsis with the remaining procedures was 13 percent (statistically significant, p = 0.03). Other complications included intraabdominal abscesses (3.3 percent), anastomotic leaks (2.5 percent), eviscerations (1.6 percent), and an operative mortality of 1.6 percent. We have concluded that whole-gut lavage and enemas and purgatives are equally efficacious mechanically with similar associated wound sepsis rates.