Hassan Malak Maaz, Ur Rahman Shafiq, Hassan Malak Bilal, Khan Taimoor, Alam Intikhab, Ahmad Atizaz, Samad Ata Us, Khan Imran
General Surgery, St. Vincent's University Hospital, Dublin, IRL.
General Surgery, Saidu Teaching Hospital, Swat, PAK.
Cureus. 2025 Mar 23;17(3):e81024. doi: 10.7759/cureus.81024. eCollection 2025 Mar.
The most suitable type of preoperative colonic preparation for colorectal surgery is controversial. Polyethylene glycol (PEG) has been widely used and some regard it as more suitable for bowel cleansing. However, it also has some limitations, such as nausea and vomiting. These problems have caused surgeons to question whether bowel cleansing offers any benefit at all. This study aims to assess the safety and efficacy of PEG, compare it with other available bowel preparations, conduct a detailed analysis of the available evidence, and inform clinical practice guidelines for bowel preparation before elective colorectal surgeries. MeSH terms and keywords, including "colorectal surgeries", "polyethylene glycol", and "placebo", were used to run a literature search on PubMed, Embase, Cochrane, and Clinicaltrials.gov from inception to January 2025. Randomized controlled trials (RCTs) comparing PEG with placebo for patients undergoing colorectal surgeries were included. Risk ratios (RRs) and 95% confidence intervals (CIs) were pooled using the Mantel-Haenszel method in RevMan (Cochrane Collaboration, London, UK). Random effects meta-analysis was undertaken. Ten RCTs with a total of 2613 patients were included. Polyethylene showed no significant benefits over placebo regarding quality of bowel preparation (RR = 1.03, 95% CI: 0.91-1.17, p = 0.64) and incidence of surgical site infections (SSIs) (RR = 1.29, 95% CI: 0.95-1.75; p = 0.11). Both groups were comparable in terms of anastomotic leak (RR = 1.14, 95% CI: 0.70-1.85, p = 0.60), intra-abdominal abscess (RR = 0.77, 95% CI: 0.36-1.65, p = 0.50), ileus (RR = 1.16, 95% CI: 0.44-3.05, p = 0.76), anastomotic dehiscence (RR = 0.79, 95% CI: 0.39-1.59, p = 0.51), vomiting (RR = 0.54, 95% CI: 0.27-1.09, p = 0.09), and repeated operations (RR = 0.66, 95% CI: 0.20-2.24, p = 0.51). PEG has no significant benefits over placebo for bowel preparation before colorectal surgeries. Further research and RCTs are necessary to identify and explore other therapeutic options for patients undergoing colorectal surgeries.
结直肠手术最适合的术前结肠准备类型存在争议。聚乙二醇（PEG）已被广泛使用，一些人认为它更适合肠道清洁。然而，它也有一些局限性，如恶心和呕吐。这些问题使外科医生质疑肠道清洁是否真的有益。本研究旨在评估PEG的安全性和有效性，将其与其他可用的肠道准备方法进行比较，对现有证据进行详细分析，并为择期结直肠手术前的肠道准备临床实践指南提供参考。使用包括“结直肠手术”、“聚乙二醇”和“安慰剂”等医学主题词和关键词，在PubMed、Embase、Cochrane和Clinicaltrials.gov上进行了从创刊到2025年1月的文献检索。纳入了比较PEG与安慰剂用于结直肠手术患者的随机对照试验（RCT）。使用RevMan（英国伦敦Cochrane协作网）中的Mantel-Haenszel方法汇总风险比（RR）和95%置信区间（CI）。进行随机效应荟萃分析。纳入了10项RCT，共2613例患者。在肠道准备质量（RR = 1.03，95% CI：0.91 - 1.17，p = 0.64）和手术部位感染（SSI）发生率（RR = 1.29，95% CI：0.95 - 1.75；p = 0.11）方面，聚乙二醇与安慰剂相比没有显著益处。两组在吻合口漏（RR = 1.14，95% CI：0.70 - 1.85，p = 0.60）、腹腔内脓肿（RR = 0.77，95% CI：0.36 - 1.65，p = 0.50）、肠梗阻（RR = 1.16，95% CI：0.44 - 3.05，p = 0.76）、吻合口裂开（RR = 0.79，95% CI：0.39 - 1.59，p = 0.51）、呕吐（RR = 0.54，95% CI：0.27 - 1.09，p = 0.09）和再次手术（RR = 0.66，95% CI：0.20 - 2.24，p = 0.51）方面具有可比性。在结直肠手术前的肠道准备中，PEG与安慰剂相比没有显著益处。有必要进行进一步的研究和RCT，以确定和探索结直肠手术患者的其他治疗选择。
